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Full text of "Report of the Health Department of the Panama Canal for the calendar year"



REPORT 

OF THE 



Health Department 



OF 



The Panama Canal 

FOR THE 

CALENDAR YEAR 
1929 

Gift of the Panama Canal Museum 




J. F. SILER 



Colonel, Medical Corps, United States Army 
Chief Health Officer 



BALBOA HEIGHTS, CANAL ZONE 



THE PANAMA CANAL PRESS 

MOUNT HOPE, C. Z. 

1931 



REPORT 

OF THE 



Health Department 



OF 



The Panama Canal 

FOR THE 

CALENDAR YEAR 
1929 




J. F. SILER 



Colonel, Medical Corps, United States Army 
Chief Health Officer 



BALBOA HEIGHTS, CANAL ZONE 



THE PANAMA CANAL PRESS 

MOUNT HOPE, C. Z. 

1931 




For additional copies of this publication address The Panama Canal, Washington. D. C. 
or Balboa Heights. Canal Zone. 



CONTENTS. 



Page. 

Title 1 

Personnel 5 

Financial statement 8 

Summary of vital statistics regarding employees only 10 

Summary of vital statistics for the Canal Zone, employees, and nonemployees. 13 

Summary of vital statistics for Panama City 14 

Summary of vital statistics for Colon 15 

Smallpox on the Isthmus of Panama 17 

Health Office, Panama City 37 

Health Office, Colon-Cristobal 38 

Division of Quarantine 41 

Gorgas Hospital 44 

Corozal Hospital - 49 

Colon Hospital 52 

Palo Seco Leper Colony 54 

Board of Health Laboratory 56 

Tables: 

I. Discharges from hospitals, deaths, and noneffective rates for em- 
ployees 67 

II. Causes of deaths of employees, arranged with reference to color, 

age, and length of residence on Isthmus 68 

III. Deaths and death rates of residents of the Canal Zone and the 

cities of Panama and Colon 70 

IV. Deaths of residents of the Canal Zone and the cities of Panama and 

Colon, by cause, sex, color, age, and place of residence 72 

V. Deaths of nonresidents by cause, sex, color, and age 78 

VI. Statistics regarding American employees and their families 80 

VII. Births and birth rates in the Canal Zone and the cities of Panama 

and Colon » 80 

VIII. Infant mortality rates in the Canal Zone and the cities of Panama 

and Colon. 80 

IX. Discharges and deaths in hospitals of The Panama Canal 81 

X. Consolidated hospital and colony report 87 

XL Number of days hospital treatment furnished, and average number 

in hospital each day, of the various classes of patients 88 

XII. Report of dispensaries 88 

XIII. Consolidated admission report, hospitals and dispensaries . 89 

# XIV. Statement of contagious and infectious diseases reported 90 

XV. Force report 90 



HEALTH DEPARTMENT. 



PERSONNEL. 



On June 15, 1929, Col. Weston P. Chamberlain, Medical Corps, 
U. S. Army, Chief Health Offieer, was relieved from duty with The 
Panama Canal, and Col. Joseph F. Siler, Medical Corps, U. S. Army, 
was appointed Chief Health Officer. January 24, 1929, Maj. Hertel 
P. Makel, Medical Corps, U. S. Army, was appointed Superintendent, 
Colon Hospital, vice Maj. John Wallace, Medical Corps, U. S. Army, 
relieved from duty with The Panama Canal. August 19, 1929, Maj. 
Sidney L. Chappell was appointed Superintendent, Corozal Hospital, 
vice Maj. Cleve C. Odom, relieved from duty with The Panama Canal. 

On December 31, 1929, there were 282 white and 891 colored em- 
ployees — a total of 1,173. The white force was divided as follows : 

31 physicians, medical officers of the 13 sanitary inspectors. 

U. S. Army. 2 quarantine inspectors. 

1 dentist, dental officer of the 6 veterinarians. 

U. S. Army. 7 technicians. 

2 physicians, surgeons of the U. S. 9 dispensary assistants. 

Public Health Service. 5 pharmacists. 

30 physicians, civilian. 14 miscellaneous — storekeeper, chem- 

10 internes. ists, stewardesses, carpenter, 

9 male nurses. foremen, mechanics, undertak- 

113 female nurses. er, vaccinator, plumber, dental 

32 clerks. hygienist, and dietist. 

The individuals filling the higher positions on December 31, 1929, 
and their respective duties, were as follows: 

CHIEF HEALTH OFFICE. 

Balboa Heights. 

Col. Joseph F. Siler, Medical Corps, U. S. Army, Chief Health Officer. 
Dr. Dalferes P. Curry, Assistant Chief Health Officer. 
Surg. Marion F. Haralson, U. S. P. H. S., Chief Quarantine Officer. 
Mr. Arthur L. Fessler, Office Assistant. 



DIVISION OF HOSPITALS AND CHARITIES. 

Gorgas Hospital. 

Col. George M. Ekwurzel, Medical Corps, U. S. Army, Superintendent. 

Maj. John W. Sherwood, Medical Corps, U. S. Army, Assistant to Superintendent. 

Mr. Elmer F. Ohlson, Executive Assistant. 

Dr. Troy W. Earhart, Chief of Surgical Service. 

Dr. Howard K. Tuttle, Assistant Chief of Surgical Service. 

Maj. Henry C. Dooling, Medical Corps, U. S. Army, Chief of Medical Service. 

Capt. Forrest R. Ostrander, Medical Corps, U. S. Army, Acting Assistant Chief 

Medical Service. 
Dr. Ivan E. Hix, Chief of Eye, Ear, Nose, and Throat Service. 
Maj. Laurent L. La Roche, Medical Corps, U. S. Army, Assistant Chief Eye, Ear, 

Nose, and Throat Service. 
Dr. Leroy S. Townsend, Chief of X-Ray Service. 

Maj. Henry W. Grady, Medical Corps, U. S. Army, Chief of Physio-Therapy Service 
Maj. Percy E. Duggins, Medical Corps, U. S. Army, Obstetrician. 
Maj. Ernest J. Steves, Medical Corps, U. S. Army, Cardiologist. 
Maj. Robert E. Thomas, Medical Corps, U. S. Army. 
Maj. Carlton L. Vanderboget, Medical Corps, U. S. Army. 
Maj. Max R. Stockton, Medical Corps, U. S. Army. 
Maj. John C. Woodland, Medical Corps, U. S. Army. 
Capt. William F. DeWitt, Medical Corps, U. S. Army. 
Capt. Emery E. Ailing, Medical Corps, U. S. Army. 
Capt. Alvin L. Gorby, Medical Corps, U. S. Army. 
Capt. Walter S. Jensen, Medical Corps, U. S. Army. 
Capt. William Kraus, Medical Corps, U. S. Army. 
Capt. Loren D. Moore, Medical Corps, U. S. Army. 
Capt. August W. Spittler, Medical Corps, U. S. Army. 
Capt. Francis W. Gustites, Medical Corps, U. S. Army. 
Capt. Arthur B. McCormick, Dental Corps, U. S. Army. 
1st Lieut. Donald C. Snyder. Medical Corps, U. S. Army 

Internes. 

Dr. James H. Chappie Dr. Alberto Navarro 

Dr. Virgil T. DeYault Dr. Ashby Steele 

Dr. Henry E. Fenton Dr. Robert C. Thompson 

Dr. Max L. Garon Dr. Glen F. Waltemath 

Dr. Henry A. Monat Dr. La Mont Whittier 

Board of Health Laboratory. 

Dr. Lewis B. Bates, Chief of Laboratory. 

Maj. George C. H. Franklin, Medical Corps, U. S. Army, Bacteriologist. 
Maj. Raymond O. Dart, Medical Corps, U. S. Army, Pathologist. 
Mr. James E. Jacob, Chemist. 



Corozal Hospital. 

Maj. Sidney L. Chappcll, Medical Corps, U. S. Army, Superintendent. 

Maj. Reeve Turner, Medical Corps, U. S. Army. 

Capt. John P. Russell, Medical Corps, U. S. Army. 

Dr. Lawrence G. Combs, Veterinarian and Dairy Manager. 

Colon Hospital. 

Maj. Hertel P. Makel, Medical Corps, U. S. Army, Superintendent. 

Dr. William V. Levy, Chief of Medical Service. 

Dr. Wayne Gilder. 

Capt. Eugene W. Billick, Medical Corps, U. S. Army. 

Capt. Leland E. Dashiell, Medical Corps, U. S. Army. 

Capt. Brooke Dodson, Medical Corps, U. S. Army. 

Maj. Raymond W. Whittier, Medical Corps, U. S. Army. 

Palo Seco Leper Colony. 

Dr. Ezra Hurwirz, Superintendent. 

Gatim Dispensary. 

Dr. James A. Grider, District Physician. 

Pedro Miguel Dispensary. 

Dr. David G. Sampson, District Physician. 
Dr. John C. Wilkinson. 
Dr. Cecil S. Mollohan. 

Balboa Dispensary. 

Dr. Littleton 0. Keen, District Physician. 
Dr. George Eugene. 
Dr. Walter C. Friday. 
Dr. Julian R.Hunt. 
Dr. William H. Presnell. 

Ancon Dispensary. 

Dr. Walter K. Olson, District Physician. 
Dr. Denver F. Gray. 

DIVISION OF SANITATION. 

Panama Health Office. 

Surgeon Paul Preble, U. S. P. H. S., Health Officer. 
Mr. James M. Carpprow, Sanitary Inspector. 
Mr. John P. Corrigan, Sanitary Inspector. 



Mr. Morris M. Seeley, Sanitary Inspector. 

Mr. George L. Willett, Sanitary Inspector. 

Mr. Jordan F. Jordan, Sanitary Inspector. 

Dr. I. C. Mattatall, Supervising Veterinarian and Meat Inspector. 

Dr. Troy S. Hopkins, Veterinarian and Meat Inspector. 

Dr. Henry A. Lewis, Vaccinator. 

Cristobal-Colon Health Office. 

Dr. Jesse L. Byrd, Health Officer. 

Mr. Thomas A. Leathley, Sanitary Inspector. 

Mr. Charles H. Bath, Sanitary Inspector. 

Mr. E. Frederick Quimby, Sanitary Inspector. 

Dr. Frederick F. Dowd, Veterinarian and Meat Inspector. 

Dr. Claire C. Clay, Veterinarian and Meat Inspector. 

Dr. William F. Gross, Veterinarian and Meat Inspector. 

Canal Zone Sanitation. 

Mr. Charles L. Pierce, Division Sanitary Inspector, Southern and Panama-Suburban 
Districts, Ancon. 

Mr. Raymond E. Forbes, Sanitary Inspector, Ancon. 

Mr. Carl G. Brown, Sanitary Inspector, Ancon. 

Mr. George A. Halloran, Sanitary Inspector, Ancon. 
Mr. Charles A. Roach, Sanitary Inspector, Northern District, Gatun. 

DIVISION OF QUARANTINE. 

Surgeon Marion F. Haralson, U. S. P. H. S., Chief Quarantine Officer (See Chief 
Health Office). 

Cristobal-Colon Quarantine, Cristobal. 

Dr. Charles A. Hearne, Quarantine Officer. 
Dr. Francis L. Alexaitis. 
Dr. Herbert L. Phillips. 
Dr. Chester J. Sturges. 



Balboa-Panama Quarantine, Balboa. 



Dr. John D. Odom, Quarantine Officer. 
Dr. Philip Horwitz. 
Dr. Samuel S. Irvin. 
Dr. Boldridge E. Kneece. 



FINANCIAL STATEMENT. 



The funds for the operation of the Health Department are derived 
from specific appropriations made annually by Congress, and from the 
earnings of the Department. 



OPERATING EXPENSES AND EARNINGS OF SUBDIVISIONS OF THE HEALTH DEPARTMENT, 

CALENDAR YEAR 1929. 





Operating 
expenses. 


Earnings. 


Per cent 

self 
support- 
ing. 


Gross cost 

per 

patient 

per day. 


Gorgas Hospital 


'$937,727.71 

^ 159,461.78 

3 213,830.50 

45,679.35 

4 86,385.94 

s 71,015.09 

140,996.86 

139,017.00 

65,986.66 

8,028.85 

6 34,092.63 


$486,057.30 

83,214.88 

187,858.65 

20,925.75 

42,665.34 

11,586.53 

8 115,177.72 
51,634.51 
23,372.48 


52 
52 
88 

v 46 

49 

16 

82 
37 
35 


$5.08 


Colon Hospital 


5.18 


Corozal Hospital (for the insane). 

Palo Seco Leper Colony 

Maritime quarantine service 


' .90 
1.25 


Sanitation of the cities of Panama 
and Colon.. .. 




Street cleaning and garbage col- 
lection and disposal, cities of 
Panama and Colon 




Canal Zone sanitation 




Line dispensaries 

Medical storehouse. 






Chief Health Office and miscel- 
laneous 


447.60 


1 








Total w 


i 1,902,222.37 


1,022,940.76 


54 





■Includes Army pay of Army medical officers, which amounted to $113,350 . 15 

Alsoincludes cost of operation of Board of Health Laboratory and Ancon Dispensary. 

'Includes Army pay of Army medical officers, which amounted to 22,265.49 

Also includes cost of operating Colon Dispensary. 

'Includes Army pay of Army medical officers, which amounted to 14 ,066 . 69 

Also includes care of cripples and chronics, and operation of farm and dairy . 

•Includes Public Health Service pay of U.S. P. H.S. officer, which amounted to 5,444.90 

s Includes Public Health Service pay of U.S. P. H.S. officer, which amounted to 116.48 

'Includes Army pay of Army medical officers, which amounted to 7 ,045 . 69 

'Includes Army and Public Health Service pay, which amounted to 162,289.40 

•Earnings inciude the 75 percent of total expense, plus 10 percent overhead, which is billed to the Re- 
public of Panama. 



OPERATING EXPENSES OF THE HEALTH DEPARTMENT, CALENDAR YEAR 
SHOWING AMOUNT CHARGED TO THE VARIOUS ACCOUNTS. 

Gold pay roll (white employees): 

Panama Canal pay $647,194.73 

Army pay 156.728.02 

Public Health Service pay 5,561.38 

Silver pay roll (colored employees) .. 

Subsistence supplies 

Ice - 

Hospital supplies and drugs 

Equipment 

Miscellaneous material and supplies. 

Laundry 

Telephones 

Repatriation of patients physically or mentally disabled 

Medical storehouse operation 

Launch service 

Electric current 

Electric repairs and installations 

Water... . v . 

Motor transportation (except for hospitals, quarantine stations, and 
dispensaries) 



1929, 



,484.13 

428,691.65 

244,034.16 

6,093.81 

88,022.72 

50,256.40 

84,381.38 

44,619.58 

15,076.28 

993.68 

8,028.85 

6,738.80 

14,998.34 

10,857.44 

14,071.93 

50,535.92 



10 



Repairs to motor transportation for hospitals, quarantine stations, 
and dispensaries 

Rental of quarters 

Freight on supplies 

Building repairs and minor construction 

Miscellaneous direct charges and services of other Panama Canal de- 
partments 



$2,035.73 
2,608.57 
1,673.19 
6,337.11 

12,682.70 



Total operating expenses 1 qq? ? 2 2 37 

Salaries of Army medical officers, and United States Public Health 
Service officers, paid from appropriations for those services.... 



162,289.40 



Total operating expenses as charged against Health De- 
partment funds I 730 932 97 

Construction items charged against Health Department funds... 27,545.99 

Total amount charged against Health Department funds... 1,767,478.96 

SUMMARY OF VITAL STATISTICS • REGARDING 
EMPLOYEES ONLY. 2 
The five following charts are for .the total employed force, which 
for the year 1929 averaged 3,505 whites and 12,688 negroes. 
Chart No. 1. -Admission Rate To Hospitals and Quarters from All Causes, 



Employees Only. 



Year. 

1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 
1914 
1915 
1916 
1917 
1918 
1919 
1920 
1921 
1922 
1923 
1924 
1925 
1926 
1927 
1928 
1929 



Average 

number 

employed 



26,547 
39,238 
43,890 
47,167 
50,802 
48,876 
50,893 
56,654 
44,329 
34,785 
33,176 
32,589 
25,520 
24,204 
20,673 
14,389 
10,447 
10,976 
11,625 
12,180 
12,732 
13,561 
14,260 
16,193 



Rate 

per 

1,000. 



1,779 
1,419 
1,132 
887 
905 
896 
727 
519 
420 
320 
283 
357 
406 
550 
672 
620 
490 
485 
513 
519 
474 
502 
595 
602 





■All rates throughout this report are computed as annual per 1,000. 

'Includes all employees of The Panama Canal and the Panama Railroad on the Isthmus: that is 
in the Canal Zone and cities of Colon and Panama. ' ' 

Active sanitary work in the Canal Zone and in the cities of Colon and Panama was undertaken 
py the United States soon after the control of the property of the French Canal Company was 
taken over in May, 190-1. Tables are therefore carried as far back toward that date as figures are 
available, to give a comparison of the results of work done since. 

The admission rate* to hospitals was 214.04 in 1929, as compared 
with 176.72 in 1928, and 146.15 in 1927. From disease alone the 



11 



admission rate to hospitals in 1929 was 179.58, as compared with 
154.42 in 1928, and 122.19 in 1927. 

Chart No. 2. — Death Rate From All Causes, Employees Only 





Average 


Rate 


Year. 


number 


per 




employed. 


1,000. 


1906 


26,547 


41.73 


1907 


39,238 


28.74 


1908 


43,890 


13.01 


1909 


47,167 


10.64 


1910 


50,802 


10.98 


1911 


48,876 


11.02 


1912 


50,893 


9.18 


1913 


56,654 


8.35 


1914 


44,329 


7.04 


1915 


34,785 


5.77 


1916 


33,176 


6.03 


1917 


32,589 


7.09 


1918 


25,520 


8.11 


1919 


24 , 204 


7.23 


1920 


20,673 


8.70 


1921 


14.389 


6.46 


1922 


10,447 


6.89 


1923 


10,976 


6.65 


1924 


11,625 


7.23 


1925 


12,180 


8.95 


1926 


12,732 


9.03 


1927 


13,561 


9.00 


1928 


14,260 


9.96 


1929 


16,193 


10.37 





The death rate from disease alone for 1929 was 9.33, as compared 
with 9.19 in 1928, and 7.82 in 1927. 

Chart No. 3. — Noneffective Rate From All Causes, Employees Only. 





Average 


Rate 


Year. 


number 


per 




employed. 


1,000. 


1906 


26,547 


28.48 


1907 


39,238 


25.09 


1908 


43,890 


22.31 


1909 


47,167 


21.93 


1910 


50,802 


24.37 


1911 


48,876 


24.46 


1912 


50,893 


21.11 


1913 


56,654 


15.97 


1914 


44,329 


12.22 


1915 


34,785 


10.28 


1916 


33,176 


9.20 


1917 


32,589 


9.65 


1918 


25,520 


11.19 


1919 


24 , 204 


14.29 


1920 


20,673 


14.87 


1921 


14 , 389 


13,96 


1922 


10,447 


14.81 


1923 


10,976 


13.78 


1924 


11,625 


13.51 


1925 


12,180 


13.77 


1926 


12,732 


12 08 


1927 


13,561 


13.81 


1928 


14.Z60 


14.66 


1929 


16,193 


15.23 



Admission rate is based on disclrarges from and deaths in hospitals, as shown in Table I, page 6/ 



12 



Chart No. 4. — Admission Rate From Malaria, Employees Only. 





Average 


Rate- 






Year. 


number 
employed. 


per 
1,000. 






1906 
1907 
1908 
1909 


26,547 
39,238 
43,890 
47,167 


821 
424 
282 
215 














1910 


50 , 802 


187 


^■MBMBI 




1911 


48,876 


184 


HBMHiHB 




1912 


50,893 


110 


BHBB1 




1913 


56,654 


76 


■■■ 




1914 


44,329 


82 


■■■ 




1915 


34,785 


51 


■■ 




1916 


33,176 


16 


■ 




1917 


32,589 


14 


1 




1918 


25,520 


18 


■ 




1919 


24,204 


31 


■ 




1920 


20,673 


19 


■ 




1921 


14,389 


15 


■ 




1922 


10,447 


17 


■ 




1923 


10,976 


19 


■ 


- 


1924 


11,625 


16 


I 




1925 


12,180 


27 


M 




1926 


12,732 


14 


1 




1927 


13,561 


11 


1 




1928 


14,260 


14 


I 




1929 


16,193 


21 


■ 





Chart No. 5. — Death Rate From Malaria, Employees Only. 





Average 


Rate 


Year. 


number 


per 




employed. 


1,000. 


1906 


26,547 


7.45 


1907 


39,238 


3.51 


1908 


43,890 


1.37 


1909 


47,167 


.85 


1910 


50,802 


.81 


1911 


48,876 


.84 


1912 


50,893 


.31 


1913 


56,654 


.30 


1914 


44,329 


.16 


1915 


34,785 


.23 


1916 


33,176 


.06 


1917 


32,589 


.09 


1918 


25,520 


.08 


1919 


24 , 204 


.08 


1920 


20,673 


.15 


1921 


14,389 


.00 


1922 


10,447 


.00 


1923 


10,976 


.00 


1924 


11,625 


.17 


1925 


12,180 


.00 


1926 


12,732 


.00 


1927 


13,561 


.00 


1928 


14,260 


.00 


1929 


16,193 


.06 




13 



The 6 diseases causing the highest number of hospital admissions 
among employees, with their rates, were as follows: 



1928. 



Admissions. 



Rate per 
1,000. 



1929. 



Admissions. 



Rate per 
1,000. 



Malaria 

Venereal diseases 

Diseases of pharynx and tonsils 

Diseases of the nasal fossae and annexa 
Diseases of the eyes and their annexa . . . 
Acute abscess 



*203 
189 
121 

49 
103 

56 



14.24 
13.25 
8.35 
3.85 
7.22 
4.40 



*337 
266 
184 
153 
113 
109 



20.81 
16.43 
11.36 
9.45 
6.98 
6.73 



*The few cas:s of malaria treated in quarters are included in this figure. 

The 6 diseases causing the highest number of deaths among em- 
ployees, with their rates, were as follows: 



Pneumonia (broncho and lobar) . 

Syphilis 

Organic diseases of the heart. . . . 
Nephritis (acute and chronic) . . . 
Tuberculosis (various organs) . . . 
Cancer (various organs) 



1928. 



Deaths. 



Rate per 
1,000. 



1.19 
1.05 
.77 
.77 
.84 
.70 



Deaths. 



Rate per 
1,000. 



1.42 
1.17 

.93 
.80 
.74 
.62 



The admission rate to hospitals from disease, and death rate from 
disease, for white employees, were 272.75 and 6.56 respectively, as 
compared with 153.85 and 10.09 for black employees. 

The death rate from disease for American (white) employees was 
6.46, as compared with 4.13 for 1928 and 4.99 for 1927. 

SUMMARY OF VITAL STATISTICS FOR THE CANAL ZONE- 
EMPLOYEES AND NONEMPLOYEES. 

From an average population of 38,825 in the Canal Zone, there 
were 298 deaths during the year; 263 of these were from disease, 
giving a rate of 6.77 as compared with 7.37 for 1928, and 7.20 for 1927. 

The death rate from tuberculosis was 0.86, as compared with 0.70 
for 1928, 0.49 for 1927, 0.65 for 1926, and 0.89 for 1925. Tuberculosis 
caused 13 per cent of all deaths from disease during the year, as com- 
pared with 10 per cent in 1928, 7 per cent in 1927, 10 per cent in 1926, 
and 13 per cent in 1925. 

There were 508 live births reported during the year, giving a birth 
rate of 13.08. (See Table VII, page 80.) Of these, 176 were white, 
and 332 were black. Of the total births reported, 6 per cent were 
stillbirths. 

Deaths among children under 1 year of age, from all causes, totaled 
48, of which 8 were white and 40 black, giving an infant mortality rate 
based on the number of live births reported during the year, of 45.45 
for white children, 120.48 for black children, and a general average of 
94.49. 



14 



Of the total deaths for all ages, 16 per cent occurred among children 
under 1 year of age, and 27 per cent among children under 5 years of 
age. 
Chart No. 6. — Death Rate From All Causes, Canal Zone Only, Employees 

AND NoNEMPLOYEES. 



Year. 


Popula- 
tion. 


Deaths. 


Rate 

per 

1,000. 


1905 


23,463 


828 


35 . 29 


1906 


34,095 


1,700 


49.86 


1907 


54,036 


1,708 


31.60 


1908 


67,146 


1,273 


18.95 


1909 


76,900 


1,025 


13.33 


1910 


86,465 


1,251 


14.47 


1911 


90,434 


1,385 


15.32 


1912 


79,279 


1,129 


14.24 


1913 


61,700 


1,047 


16.97 


1914 


46,379 


710 


15.31 


1915 


31,496 


410 


12. S3 


1916 


31,447 


343 


10.91 


1917 


33,044 


328 


9.93 


19J8 


33 , 803 


286 


8.49 


1919 


32,366 


247 


7.63 


1920 


27,459 


242 


8.81 


1921 


31,377 


236 


7.52 


1922 


31,098 


254 


8.17 


1923 


31,793 


253 


7.96 


1924 


33 , 723 


305 


9.05 


1925 


34 , 840 


297 


8 . 53 


1926 


36 , 480 


284 


7.79 


1927 


36,794 


298 


8.10 


1928 


37,056 


316 


8.53 


1929 


38,825 


298 


7.67 




SUMMARY OF VITAL STATISTICS FOR PANAMA CITY. 

From an estimated population of 73,000, there were 1,413 deaths. 
Of these, 1,370 were from disease, giving a rate from disease of 18.77, 
as compared with 19.44 in 1928, and 17.16 in 1927. 

In the previous annual reports the population figures since 1920 
have been based on the census of that year. Chart No. 7 of this re- 
port shows revised figures and rates from 1920 to date. A census was 
taken early in 1930 which showed the population to be 74,402, and in 
order to record the gradual increase in population which took place,, 
the figures were revised, taking the 1920 and 1930 official censuses as 
bases, and filling in the intervening years by arithmetical progression. 

The 6 diseases causing the highest number of deaths, with their 
rates, were as follows: 



Pneumonia, broncho and lobar 

Tuberculosis (various organs ) 

Diarrhea and entritis (including colitis) 

Organic diseases of the heart 

Nephritis, acute and chronic 

Cancer (various organs) 



1928. 



Deaths. 



Kate per 
1,000. 



248 
227 
117 
105 
115 
44 



3.47 
3.17 

1.64 

1.47 

1.61 

.62 



1929. 



Deaths. 



231 
204 
148 
118 
114 
67 



Rate per 
1,000. 



3.16 
2.79 
2.03 
1.62 
1.56 



15 



The death rate from tuberculosis was 2.79, as compared with 3.17 
for 1928, 2.57 for 1927, and 2.95 for 1926. Tuberculosis caused 15 per 
cent of all deaths from disease, as compared with 16 per cent in 1928, 
14 per cent in 1927, 18 per cent in 1926, and 19 per cent in 1925. 

There were 2,392 live births reported during the year, giving a birth 
rate of 32.77. Of the total births reported, 5 per cent were stillbirths. 

There were 3,59 deaths among children under 1 year of age, giving an 
infant mortality rate, based on the number of live births reported 
during the year, of 141.72. 

Of the total deaths for all ages. 24 per cent occurred among children 
under 1 year of age, and 34 per cent among children under 5 years of 
age. 

Chart No. 7. — Death Rate From All Calses, City of Panama. 



1905 
1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 
1914 
1915 
1916 
1917 
1918 
1919 
1920 
1921 
1922 
1923 
1924 
1925 
1926 
1927 
1928 
1929 



Popula- 
tion. 



Deaths. 



21,984 

25,518 
33 , 548 
37,073 
40,801 
45.591 
46,555 
47,057 
47,172 
53 , 948 
60,373 
60,778 
61,074 
61,369 
61,369 
59.458 
61,000 
62.500 
64,000 
65 . 500 
67,000 
68 , 500 
70 , 000 
71,500 
73.000 



1,447 

1,142 

1,156 

1,292 

1,038 

1,446 

1,456 

1,380 

1,507 

1,863 

1,810 

1,765 

1,714 

1,314 

1,211 

1,297 

1,336 

1,279 

1.106 

1,168 

1,169 

1 , 1 88 

1,248 

1 ,434 

1,413 



Rate 

per 

1,000. 



65.82 
44.75 
34.45 
34.83 
25.44 
31.72 
31.27 
29.33 
31.95 
34.53 
29.98 
29.04 
28.06 
21.41 
19.74 
21.81 
21.90 
20.46 
17.28 
17.83 
17.45 
17.34 
17.83 
20.06 
19.36 




SUMMARY OF VITAL STATISTICS FOR COLON. 

From an estimated population of 29,850, there were 492 deaths 
during the year; of these, 467 were from disease, giving a rate of 15.64, 
as compared with 14.20 for 1928, and 13.40 for 1927. 

In the previous annual reports the population figures since 1920 
have been based on the census of that year. Chart No. 8 of this 
report shows revised figures and rates from 1920 to date. A census 
was taken early in 1930 which showed the population to be 29,765, 
and in order to record the gradual decrease in population which took 
place, the figures were revised, taking the 1920 and 1930 official 



16 



censuses as bases, and filling in the intervening years by arithmeti- 
cal progression. 

The 6 diseases causing the highest number of deaths, with their 
rates, were as follows: 



1928. 



Deaths. 



Rate per 
1,000. 



1929. 



Deaths. 



Rate per 
1,000. 



Tuberculosis, various organs . . 
Pneumonia, broncho and lobar 

Diarrhea and enteritis 

Nephritis, acute and chronic. . 

Apoplexy 

Organic diseases of the heart . . 



2.10 
2.27 
.90 
.77 
.63 
.47 



2.14 
2.11 
1.04 
1.01 
.94 
.94 



The death rate from tuberculosis was 2.14, as compared with 2.10 
for 1928, 2.65 for 1927, and 2.54 for 1926. Tuberculosis caused 
approximately 14 per cent of all deaths from disease, as compared 
with 15 per cent in 1928, 19 per cent in 1927, 18 per cent in 1926, and 
17 per cent in 1925. 

Th#re were 822 live births reported during the year, giving a birth 
rate of 27.54. Of the total births reported, 5 per cent were stillbirths. 

There were 95 deaths among children under 1 year of age, giving an 
infant mortality rate, 'based on the number of live births reported 
during the year, of 115.57. 

Of the total deaths for all ages, 19 per cent occurred among children 
under 1 year of age, and 27 per cent among children under 5 years of 

age. 

Chart No. 8. — Death Rate From All Causes, City of Colon. 









Rate 




Year. 


Popula- 
tion. 


Deaths. 


per 
1,000. 




1905 
1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 
1914 
1915 
1916 
1917 
1918 
1919 
1920 
1921 


11,176 
13,651 
14,549 
15,878 
17,479 
19,535 
19,947 
20,174 
20,232 
23,265 
29,331 
24,693 
25,386 
26,078 
26,078 
31,203 
31,050 


553 

703 
571 
418 
396 
514 
527 
493 
489 
590 
640 
696 
667 
616 
573 
554 
497 


49.48 
51.42 
39.24 
26.32 
22.65 
26.31 
26.42 
24.44 
24.17 
25.36 
21.82 
28.19 
26.27 
23.62 
21.97 
17.75 
16.01 




































1922 


30,900 


445 


14.40 


m^^MMH 


1923 


30,750 


393 


12.78 


■■MB8B1 


1924 


30,600 


475 


15.52 


zmmmami^u^m 


1925 


30,450 


401 


13.17 


IHM^HHl 


1926 


30,300 


452 


14.92 


g^lBH 


1927 


30,150 


423 


14.03 


■i^HI^M 


1928 


30,000 


442 


14.73 


^■■MHIM 


1929 


29,850 


492 


16.48 


■MMMH3H 



SMALLPOX ON THE ISTHMUS OF PANAMA. 

An extensive nonvirulent epidemic of smallpox having occurred in 
the City of Panama in the fall of 1929, it is opportune to review the 
history of smallpox on the Isthmus of Panama in this annual report. 

During the period of construction by the French company, smallpox 
epidemics of a virulent nature occurred from time to time, notably 
in 1885-1888, and 1901-1903. Since 1904, when the United States 
undertook construction of the Canal, though epidemics have occurred 
at times, the death rate has been extraordinarily low. Mortality rates 
from smallpox in Panama City and in the Canal Zone are available 
for the period 1885-1929, as indicated in table and shown graphically 
in the chart on opposite page. 

STATEMENT SHOWING DEATHS AND DEATH RATES FROM SMALLPOX ON THE 
ISTHMUS OF PANAMA, AMONG RESIDENTS AND NONRESIDENTS. 



Year. 


Panama City. 


Colon. 


Canal Zone. 


Total deaths. 


Deaths. 


Rate per 
thousand. 


Deaths. 


Rate per 
thousand. 


Deaths. 


Rate per 
thousand. 


Resi- 
dents. 


Nonresi- 
dents. 


Total. 


1906 






2 


.1465 






2 


1 


2 


1907. .. 










1 


1916 . 


1 
1 
1 


.0164 
.0164 
.0137 










1 
2 
1 


1 


1921 






1 


.0319 


2 


1929 






1 















Note. — No deaths occurred in the years not shown. 

The most striking fact shown by the chart is the contrast in death 
rates from smallpox during the period of construction by the French 
company, and later under the auspices of the United States of America. 
It will also be noted that during the period of construction by the 
French company death rates from smallpox were high in the construc- 
tion forces as well as in the population of Panama City, whereas since 
1904 the death rates have been exceedingly low for both groups. 
Between 1881 and 1904 there were 761 persons reported as having 
died of smallpox in Panama City and among employees of the French 
company (French employees, 155; Panama City, 606), and from 1904 
to 1929, inclusive, only 6 deaths were reported (Canal Zone, 1 ; Panama 
City, 3, Colon, 2). 



17 



MR 21831- 



18 



This striking contrast in the number of deaths from smallpox under 
the two regimes (French and American) is evidence of the efficacy of 
vaccination as a protective measure. During the period of construc- 
tion by the French company, efficient vaccination was not adequately 
carried into effect either in their own forces or in the population of 
Panama City. 

Since 1904 special efforts have been made to protect all individuals 
living in the Canal Zone by vaccination. This also applies to the 
population of the two terminal cities, but greatest emphasis has been 
placed on the vaccination of school children and infants. 

Smallpox morbidity rates for three groups of the population on the 
Isthmus — Panama City, Colon, and Canal Zone — are available from 
1904 to 1929, inclusive, and are incorporated in table and shown 
graphically in the chart following: 

STATEMENT OF SMALLPOX CASES OCCURRING ON THE ISTHMUS OF PANAMA. 
AMONG RESIDENTS AND NONRESIDENTS. 





Panama City. 


Colon. 


Canal Zone. 


Total cases. 


Year. 


Popu- 
lation. 


Cases. 


Rate 
per M. 


Popu- 
lation. 


Cases. 


Rate 
per M. 


Popu- 
lation. 


Cases. 


Rate 
per M. 


Resi- 
dents. 


Non- 
resi- 
dents. 


Total 


1904 


24,548 
21,984 
25,518 
33,548 
37,073 
40,801 
45,591 
46,555 
47,057 
47,172 
53,948 
60,373 
60,778 
61,074 
61,369 
61,369 
■59,458 
61,000 
62,500 
64,000 
65,500 
67,000 
68,500 
70,000 
71,500 
73,000 
■74,402 




















2 
2 
2 
10 


2 


1905 






11.17H 
13,651 
14,549 
15,878 
17,479 
19,535 
19,947 
20,174 
20,232 
23,265 
29,331 
24,693 
25,386 
26,078 
26,078 
■31,203 
31,050 
30,900 
30,750 
30,600 
30,450 
30,300 
30,150 
30,000 
29,850 
■29,765 






23,463 
34,095 
54,036 
67,146 
76,900 
86,465 
90,434 
79,279 
61,700 
46,379 
31,496 
31,447 
33,044 
33,803 
32,366 
27,459 
31,377 
31,098 
31,793 
33 , 723 
34,840 
36,480 
36,794 
37,056 
38,825 
39,467 








2 


1906 






39 


2.86 






39 

1 


41 


1907 






1 


.02 


11 


1908 












1909 
















1 


1 


1910 


















1911 




















1912 




















1913 
















1 

1 

1 

1 

1 

29 

4 

11 

41 

3 


1 


1914 . 
















1 


1915 
















1 


1916 


2 


.03 










2 


3 


1917 










1 


1918 


102 

53 

14 

54 

3 


1.66 
.86 
.24 
.88 
.05 


2 

8 


.08 
.31 






104 
62 
14 

167 
4 


133 


1919 


1 


.03 


60 


1920 


25 


1921 


108 
1 


3.48 
.03 


5 


.16 


208 


1922 


7 


1923 








1924 
















1925 




















1926 




















1927 




















1928 






1 

28 


.03 
.94 






1 
372 


1 
25 


2 


1929 


339 


4.64 


5 


.13 


397 


1930 
























Total . . 




567 






187 






12 




766 


136 


902 

















■ The population figures shown for the years 1920 and 1930, for the cities of Panama and Colon, are as shown in 
the official censuses of the Panamanian Government. The figures for 1920 and the intervening years are revised 
from the figures previously used in annual reports and other statistics, taking the 1920 and 1930 official censuses as 
bases and filling in the intervening years by arithmetical increases or decreases. 

The marked variation in the population figures before 1920 would seem to indicate that a revision thereof should 
be made — particularly for the city of Panama in 1905, and for the city of Colon in 1915. However, as there was con- 
siderable fluctuation in the population incident to the completion of the Canal, and the depopulation of nonemployees 
from the Canal Zone in 1912, it is deemed impracticable to make revision further back than 1920. 



19 



< 



m. 



o 



OOOOOO — -~- _± ^J _ o>i<N}<-Nic\ic>Jc\}c\jc\4c\)c\4 



20 

The important facts shown in the tables and charts are: 

(a) The occurrence of epidemics in the two terminal cities 
about every five to ten years. 

(b) The failure of smallpox to gain a foothold in the population 
of the Canal Zone, notwithstanding that the permanent Canal 
Zone residential settlements at the Atlantic and Pacific entrances 
are in immediate juxtaposition to the Panamanian cities of Colon 
and Panama, and the populations intermingle freely at all times. 
Thorough vaccination of the residents of the Canal Zone has 
prevented the spread of the disease to that population. 

(c) The low grade of virulence of the smallpox prevailing, with 
exceedingly low death rates, due to the widespread practice of 
vaccination in the terminal cities (Colon and Panama). 

In reviewing vaccination requirements on the Isthmus, it is well to 
bear in mind that two groups of population are involved, actual 
residents of the Canal Zone on the one hand and the population of the 
two terminal cities on the other. Even though the regulations cover- 
ing the two groups are practically identical, the administrative 
machinery existent in the Zone for carrying the regulations into effect 
is greatly superior to that existing in the two terminal cities, and 
there is not the shift of population in the Zone that is occurring 
continuously in the terminal cities, and particularly in Panama City 
(addition to the population from the outlying provinces). 

Considering, first, conditions in the Canal Zone, the following may 
be said: Since initiation of construction under American auspices, it 
has been the practice that all individuals (American and foreign) 
coming to the Isthmus for residence must present satisfactory evidence 
of recent successful vaccination, failing which, vaccination has been 
required. For many years health regulations have required that all 
newborn children must be vaccinated three months after birth and 
vaccination of all school children requiring it is practiced each year. 

The regulations covering vaccination on the Canal Zone since 1915 
are as follows: 

Section 1. Every person living in the Canal Zone who has not been successfully 
vaccinated within five years, or who has not had an attack of smallpox (which facts 
shall be determined by the Chief Health Officer) shall submit to vaccination to the 
satisfaction of that officer unless, in his opinion, the person is not a fit subject for 
vaccination; and it shall be the duty of every person having the care, custody, or 
control of any minor or other individual over three months of age, to cause such minor 
or individual to be properly and effectively vaccinated. Certificates of successful 
vaccination will be issued by the Chief Health Officer, or by other persons designated 
by him. Vaccination will be done gratis. 

Sec. 2. Any person failing or refusing to comply with the provisions of this ordi- 
nance shall be deemed guilty of a misdemeanor. 



21 

The population of the Canal Zone is located in the main in permanent 
towns and villages and their minor medical ailments are cared for 
by five dispensaries administered by district physicians. All birth 
certificates pass through the hands of the district physician concerned, 
and it is his responsibility to prepare a vaccination card for each child 
born in his area and to see that the child is vaccinated three months 
after birth. These records are checked from time to time by the Chief 
Health Officer. 

The status of the vaccination of every school child in the Canal Zone 
is investigated as part of the routine annual physical examination of 
school children, and those requiring vaccination are referred to and 
vaccinated by district physicians. 

The regulation requiring revaccination at 5-year intervals has been 
efficiently enforced so long as the individual is in school, but in the case 
of adults it has not been systematically applied. In the case of 
American employees and their families, however, vaccination at 
5 -year intervals is fairly well accomplished, as most of the employees 
and their families visit the United States from time to time and the 
vaccination status of all incoming passengers who are prospective 
residents is carefully inquired into and revaccination in accordance 
with Panama Canal regulations is required. Systematic revaccination 
of alien employees (colored) and the adult members of their families 
has not heretofore been carried out. The proportion of American to 
alien employees (colored) has been for many years about 1 to 3 or 4. 
The assumption has been that if initial vaccination is done soon after 
birth with revaccinations at 5-year intervals during school years, 
provided the adults have been protected by vaccination at some time 
during their life, smallpox can occur only in sporadic form in the 
population. That this assumption is a sound one is adequately 
demonstrated in table and chart on pages 18 and 19. From 1904 to 
1929, inclusive, only 12 cases of smallpox occurred in residents of the 
Canal Zone, whereas during the same period 754 cases were reported 
from Panama and Colon (Panama, 567; Colon, 187). 

From time to time individuals with active smallpox have been 
detected by quarantine officers in passengers or the crews of incoming 
steamers and it has been the custom to treat them in hospital or at the 
quarantine stations. The records indicate that from 1904 to 1929, 
inclusive, 19 such cases were discovered. 

The occurrence of sporadic cases of smallpox in the Canal Zone has 
been coincident with the prevalence of the disease in the two terminal 
cities and due to exposure thereto. 



22 

Considering next the status of protection from smallpox in the two 
terminal cities it should be stated that the Convention between the 
United States and the Republic of Panama in force since November 18, 
1903, provides that: 

The Republic of Panama agrees that the cities of Panama and Colon shall comply 
in perpetuity with the sanitary ordinances whether of a preventive or curative charac- 
ter prescribed by the United States, and in case the Government of Panama is unable 
or fails in its duty to enforce this compliance by the cities of Panama and Colon with 
the sanitary ordinances of the United States the Republic of Panama grants to the 
United States the right and authority to enforce the same. 

Under the provisions of that Convention the following regulations 
governing protection from smallpox were stipulated and promulgated 
as a decree by the President of the Republic of Panama: 

Sec. 29. Every person living in the cities of Colon and Panama, respectively, who 
has not been successfully vaccinated within five years or who has not had an attack 
of smallpox (which facts shall be determined by the Health Officer) shall submit to vac- 
cination to the satisfaction of the Health Officer; and it shall be the duty of every 
person having the care, custody, or control of any minor or other individual over 
three months of age, to cause such minor or individual to be promptly and effectively 
vaccinated. Certificate of successful vaccination will be issued by the Health Officer 
or by other persons designated by that official. The Health Officer will perform 
vaccination gratis. 

Sec. 30. It shall be the duty of presidents, principals, managers, or any person 
having charge of any educational institution, orphanage, or asylum, or other places 
where children are educated, reared, or cared for, to exclude from such institutions 
all children who have not been successfully vaccinated or who are not immune from 
smallpox by having previously had an attack of that disease. It shall be the duty of 
principals, directors, or of any other person or persons in charge of such institutions, 
schools, or asylums, to require the vaccination of all children entering their institu- 
tions, immediately after they come under their care. 

Sec 31. A failure to comply with any of the provisions of sections 29 and 30 of 
these regulations, shall subject the person or persons thus offending to a fine of not 
less than five balboas nor more than twenty-five balboas for each offense. 

The health services of the two Panamanian cities, Panama and 
Colon, are administered by personnel provided by The Panama Canal; 
the entire expense of sanitation proper is borne by The Panama Canal; 
one-fourth the expense of street cleaning and garbage collection and 
disposal is borne by The Panama Canal, and three-fourths by the 
Panamanian Government. In the Republic of Panama, as is the 
case with all newly created national governments, the establishment 
and development of hospital facilities and a health service are a process 
of evolution. The Republic of Panama, which came into being on 
November 3, 1903, first concentrated on hospitalization for its popu- 
lation, especially that portion residing in and near Panama- City, 
its national capital, and not until 1926 was the organization and 
development of a national department of health undertaken. For a 



23 

number of years subsequent to 1904 the transportation facilities into 
Panama City were principally by coastwise steamers and sailboats, 
and there was, comparatively speaking, but little contact between the 
populations of the outlying provinces and the two terminal cities. 
During this same period no national health organization for the 
Republic existed and general periodic vaccination was not practiced. 
Epidemics of smallpox occured in the outlying provinces from time 
to time and when the Panama Canal authorities became aware of them 
it was the practice of the Panama Canal Health Department in co- 
operation with the Government of the Republic of Panama to send 
out vaccinating units to carry out general vaccination in the areas in 
which the disease was known to exist. 

The following examples of such cooperation are cited : In Novem- 
ber, 1906, as the result of an epidemic of smallpox prevailing in 
the Province of Los Santos, a vaccinating unit consisting of two 
physicians and a vaccinator of the Canal health service and a repre- 
sentative of the Government of Panama was sent to various towns 
and villages in the province where they vaccinated 1,145 persons. 
The following month a unit visited Aguadulce, Chiriqui, San Felipe, 
and other towns, where 229 individuals were vaccinated. On the occur- 
rence of an epidemic in San Carlos, a unit was dispatched to that area 
in June, 1909, and about 1,000 persons were vaccinated. The prev- 
alence of an epidemic in Chiriqui province (David) in April, 1909, 
resulted in the dispatch of a vaccinating unit to that area where 4,100 
persons were vaccinated in 27 villages. Another widespread epidemic 
occurred in many parts of the Republic during the period 1918-1921, 
and vaccinating units were sent out to various parts of the Republic. 

Since the organization of a national health service for the Republic 
in 1926, this service has begun gradually to practice general vaccination 
in areas from which smallpox has been reported. The Director of 
Public Health of the Republic has been unable to secure funds in his 
annual budgets for the initiation of a general vaccination program 
throughout the country. In 1929, as the result of an epidemic in 
Panama City and at various points elsewhere in the Republic, the 
President of Panama made available a special fund of $30,000, for the 
purpose of carrying out a general vaccination program throughout the 
country, and for the first time since the foundation of the Republic an 
effort has been made to vaccinate the entire population. As a result 
of the general vaccination program initiated in 1929, and continued in 
1930, the population of the Republic of Panama is at the present time 
more adequately protected from smallpox than has ever before been the 
case. 



24 

During recent years improvement in transportation facilities has 
developed a new factor of the utmost potential importance in the 
spread of smallpox. The Government of Panama has initiated am- 
bitious road development projects and at the present time good hard- 
surfaced roads are available on the Pacific side to Chepo (42 miles 
east) and to Sona (196 miles west). It is anticipated that within a 
year or so good roads will be available as far as David in Chiriqui 
province (358 miles west). This province borders on Costa Rica. 
The opening of these highways has brought the populations of Panama 
City and the provincial districts into intimate contact, through 
private and public automobile service which has been increasing 
rapidly during recent years and will continue to increase in the future. 

The recent epidemics of smallpox in Panama City, notably those in 
1918-1921, and in 1929, were due to the introduction of the disease 
from sources outside the areas controlled by the Health Department 
of the Panama Canal ; with the continuing improvement in transpor- 
tation facilities by land, it can be anticipated that the possibilities 
of the introduction of smallpox into the two terminal cities will increase 
enormously unless systematic vaccination throughout the Republic as 
well as in the two terminal cities is continuously carried on as a general 
and unvarying policy. 

Another important factor governing the occurrence of smallpox in 
Panama City has been therapid increase in its population (1904, 24,500; 
1914, 54,000; 1924, 65,500; 1929, 73,000). The additional population 
consists mainly of individuals and families moving into the capital 
city from the various provinces of the Republic, a large proportion of 
whom have never been vaccinated. 

The increase in population in Colon has been small as compared with 
Panama City (1904, 23,500; 1929, 29,850) due to its inaccessibility by 
land and restricted area suitable for building purposes. 

The vaccination policy heretofore carried out in Panama City and 
Colon has been to vaccinate the new born, and to canvass the schools 
each year, vaccinating those requiring it. In addition, it has been the 
policy to vaccinate contacts on the occurrence of sporadic cases, to 
extend vaccinations to wider areas on the occurrence of secondary 
cases, and to undertake general vaccination when epidemic threatens. 
With the rapid increase in population and ease of accessibility by 
improved roads, additional protective measures will be necessary in 
the future. 

If and when the Panamanian Government includes in its public 
health program periodic vaccination of its entire populations, together 
with vaccination of the new born and vaccination annually of school 
children, the danger of occurrence of epidemics will be eliminated. 



25 

Pending the initiation of such a program by the Panamanian Govern- 
ment, it will be necessary to carry out a general vaccination program in 
the two terminal cities every three to five years to supplement the 
vaccination of the new born and school children. 

Smallpox in epidemic or semi-epidemic proportions has occurred in 
Panama City and Colon during the following years since 1904 : Panama 
City, 1918 to 1921, inclusive, and 1929; Colon, 1906, 1921, and 1929. 

The epidemic in Panama City in 1918-1921 began in June, 1918, 
and the epidemiological evidence collected indicates that the disease 
was introduced into the city by a person who lived in the vicinity of 
La Pintura in the Province of Code. The patient stated that "there 
were plenty of cases where she came from." Three secondary cases 
occurring in June and July were exposed to the primary case referred 
to above. The number of cases reported from Panama City during 
each year of the epidemic was as follows: 1918, 102; 1919, 53; 1920, 14; 
1921, 54. . The disease was not virulent, as only one patient died. A 
general vaccination program was initiated and the records indicate 
that 61,621 vaccinations were done in 1918. During the period 1918— 
1921, smallpox prevailed in epiclemic form in various provinces of the 
Republic. It appears probable that the difficulty experienced in 
quickly eliminating the disease from Panama City was due in large part 
,to the fact that an extensive epidemic was sweeping over the Republic 
during the same period, that the Panamanian governmental author- 
ities made no concerted effort to stamp it out through wholesale 
vaccination of the population in general, and that the general vacci- 
nation program instituted in Panama City was not sufficiently drastic 
and comprehensive. At that time Panama City was also becoming 
more accessible through improvement in roads and there was a pro- 
nounced influx of population into the city from the infected areas in 
the country. The next epidemic in Panama City, which occurred in 
1929, will be discussed in detail subsequently. 

A small epidemic occurred in Colon in 1906, consisting of a total of 
39 cases for the year. The original source of infection appears to have 
been a 4-year-old child from Venezuela, who arrived in Colon on 
May 21, 1906. The child became ill four days after arrival and devel- 
oped an eruption, but the case was not brought to the attention of the 
health authorities. Three secondary cases giving a history of exposure 
to the primary case were discovered and from this initial focus a total 
of 38 cases developed. A general vaccination program was immedi- 
ately put into effect and the disease was quickly eliminated. 

An epidemic of low virulence occurred in Colon in 1921, with a total 
of 108 cases and no deaths. General vaccination quickly terminated 



26 

the epidemic. It was during this period that an epidemic was pre- 
vailing in the provinces. 

During the early months of 1929, evidence began to accumulate 
that smallpox was occurring in some of the provinces of the Republic. 
In January, 1929, a patient in the incubationary stage was admitted to 
Santo Tomas Hospital from Chorrera. On January 29, 1929, the 
Health Officer of Panama City reported to the Chief Health Officer of 
The Panama Canal that smallpox was prevailing in Chorrera. He 
had visited this town, which is about 30 miles from Panama City on the 
main road running west, accompanied by the Director of Health of the 
Republic. Two cases were detected, and 65 persons vaccinated that 
day. Recommendation was made that investigation be made of the 
smallpox situation at Chepo, Pacora, Taboga, Chorrera, and as far 
southwest as San Carlos; especially of Chorrera, between which point 
and Panama City busses ply at hourly intervals. 

On June 17, 1929, a smallpox suspect was admitted to Gorgas 
Hospital, a positive diagnosis being made on the following day. This 
case was the first reported case of a widespread epidemic of non- 
virulent smallpox in Panama City, which ended in October. During 
the epidemic, 339 cases, with 1 death, occurred in Panama City. 
This fatality, though reported as smallpox, was actually due to lobar 
pneumonia. 

From available data, the epidemic appears to have originated from 
an unrecognized case. The wife and daughter of the smallpox patient 
admitted to the hospital on June 17 had visited the interior of the 
Republic of Panama several weeks previously. About 20 days after 
their return to Panama City, the daughter became ill and developed 
an eruption which persisted for about 8 days. The mother did not 
think it necessary to call a doctor as the child, apparently, was not 
very ill. Following the child's recovery, and within the incubation 
period, the father became ill and was treated in Gorgas Hospital for 
smallpox. 

No other case occurred during the month of June. Six cases 
occurred in July prior to the 25th, in all of whom exposure could be 
traced to the original focus of infection. The Health Department felt 
no apprehension of any spread of the disease until July 25, when four 
additional cases were reported. 

The usual Health Department routine of vaccinating all contacts was 
followed in connection with the cases reported prior to July 25. On 
this date, general vaccination of the population residing in the. infected 
district was instituted. This was begun on July 26, additional person- 
nel being employed for the purpose. 



27 

This plan was very shortly extended to cover schools in the threaten- 
ed district. Within a few days the program was further extended to 
cover all the schools of the city. General vaccinations along these 
lines were continued during the month of August and for the first 
week in September. During this period about 10,000 persons were 
vaccinated, principally school children and children of pre-school age. 

During the first week of September, when occasional cases began 
to be reported from other districts in Panama City, it was decided that 
in order to check and limit its spread it would be necessary to institute 
a general vaccination program for the cities of Panama and Colon, 
as well as for the population of the Canal Zone. This decision was 
reached after representative samples of the population of the two ter- 
minal cities had been surveyed to determine their vaccination status. 
The survey indicated that between 15 per cent and 25 per cent of the 
population had either never been vaccinated or had not been vacci- 
nated for many years. 

The last general vaccination for Panama City had been in 1918, 
when 61,621 vaccinations were performed. In 1921 a similiar pro- 
gram was instituted in Colon, 19,824 vaccinations having been done. 

When the general vaccination program was decided upon, Dr. 
Guillermo G. de Paredes, Director af Hygiene and Public Health for 
the Republic of Panama, offered the full assistance of his department. 
The organization planned and developed, utilized all available medical 
personnel of the two health departments (Canal Zone and Panama), 
and a considerable number of vaccinating units were secured from other 
sources. Through favorable newspaper publicity and health depart- 
ment circulars the population of the two cities as well as the residents 
of the Canal Zone were advised of the necessity for being protected 
against smallpox by vaccination. 

The general plans followed are incorporated in the following perti- 
nent circulars and letters of instructions: 

September 4, 1929. 
Memorandum for Health Officer, Panama. 

In accordance with our conversation of yesterday relative to the vaccination pro- 
gram for Panama City, the following draft of my understanding of the plan is sub- 
mitted for your approval. This plan should be adhered to as closely as possible and 
made effective at once. 

1. The city will be divided into two tentative divisions, one division being the 
southeastern section of the city, bounded by Calle 16-Waterfront-Central Ave. to 
"L" St. to 4th of July Ave.-to Calle B-20th St. -Waterfront, and the other section 
comprising the remainder of the city. 

The division of the city referred to in Paragraph 1, to follow the line from Water- 
front down 20th St. East to Street B-to 4th of July Ave.-to L St. -to Central Ave.-to 
16th St. -to Colon St. and then down 15th St. to the Waterfront. 



28 

Dr. G. G. de Paredes has kindly consented to exercise immediate supervision over 
the first section, as well as to revaccinate all the school children of the city who have 
not been vaccinated during the past few weeks. 

It is planned to place one full-time, and, if possible, two half-time Panama 
physicians on duty under the Health Department to cover the southeastern section 
of the city under Dr. Paredes' general direction. These doctors will be assisted by 
Panama nurses. 

The school children will be covered by the Panama school physicians through the 
cooperation and courtesy of Dr. Paredes. It is understood that all children above 
seven (7) years of age who have not been vaccinated within the past few weeks, will 
be vaccinated, and those under this age will be checked for evidence of a successful 
vaccination. Those of this latter group who do not show signs of a successful vacci- 
nation will also be vaccinated. 

It is also further understood that cards will be made out on all school children. 

The second division of the city will be under the direct supervision of your office. 

It is planned to increase the force of vaccinators to seven (7) men, all of these to 
be assisted by a silver employee or a Panama nurse. The city will then be covered 
by a general vaccination, block by block. 

A record of each day's work completed should be filed in your office. 

2. One vaccination team consisting of a vaccinator and assistant is to be available 
for foci vaccination as long as a case of smallpox makes its appearance. Every effort 
should be made to vaccinate all possible contacts, and cards made out on all residents 
of the premises from which a case is apprehended. 

3. Attendant Lawrence will complete a card record of all births since July 1, 1928, 
and will then vaccinate all infants so recorded. 

4. Dr. Hopkins will be available for office vaccination between the hours of 11 and 
12, and will also cover the vaccination of all dairy employees as soon as possible. 

5. Dr. Haralson, Chief Quarantine Officer, will have general charge of the vacci- 
nation program for Panama and Colon. He will cooperate with you and Dr. Paredes 
to the fullest extent and relieve you of as much detail as is possible. 

The idea of this office is to facilitate the accomplishment of this wprk by all avail- 
able means and assist to such an extent that you will have sufficient time available 
for your necessary regular duties. 

6. Your endorsement hereon, and return of this letter to my office, will indicate 
your approval of this plan. 

Respectfully, 

J. F. Siler, 
Chief Health Officer. 



September 11, 1929. 
General Instructions to Vaccinators. 

All personnel will report to this office at 7 o'clock each morning and return at noon 
for the replenishing of supplies of ice, vaccine, and equipment. They will also return 
at the close of the day and place all remaining vaccine in the refrigerator. It is 
important that vaccine be kept cold at all times. 

Each vaccinator will be furnished with a 1-gallon capacity vacuum jug Tor trans- 
porting the vaccine, as well as a bag containing the necessary equipment. The vacci- 
nator to whom these are issued, will be held personally responsible for the property. 



29 

Each vaccinator will be assigned a nurse and a policeman. The nurse will assist 
the vaccinator, and the policeman will see that all individuals of each house or block 
present themselves to the vaccinator. In the event of the refusal of any individual 
to have vaccination performed, the name and address will be recorded and reported 
to this office. 

Each vaccinator will be held responsible for the complete vaccination of the district 
to which he is assigned, and will keep a complete record, by date, of the street, block, 
and house number of area vaccinated, giving this information under the headings 
Morning and Afternoon. Memo books will be furnished. 

Extreme care should be exercised in the peformance of all vaccinations and rigid 
technique practiced. The arm should first be carefully cleansed with alcohol, and 
then thoroughly dried. A small amount of vaccine should be applied and the vacci- 
nation performed by the multiple puncture method. Any residue remaining on the 
arm after completion of the vaccination may be removed with cotton by gentle blot- 
ting. By a careful application of the vaccine, a sufficient amount is contained in 
each tube to vaccinate at least two individuals. Caution all persons against the use 
of dressings or shields of any kind. 

No one should be exempted from vaccination unless visual evidence of a recent vacci- 
nation, or evidence of physical debility, is shown (as explained: Boils, skin diseases, 
nephritis, diabetes). If any questions arise from time to time, they will be taken up 
in the office. 

M. F. Haralson. 

Balboa Heights, C. Z., September 13, 1929. 
To All Concerned: 

1. Due to the continued presence of smallpox in the neighboring Republic of Pana- 
ma, and especially because of the fact that there is at the present time an epidemic 
of the disease in the city of Panama, it becomes necessary to check the degree of 
compliance with the law which requires vaccination of those residing in the Canal 
Zone. 

2. It is therefore directed that every employee of The Panama Canal, the family 
of every employee, and all other persons (Army and Navy personnel excepted who 
will be taken care of by their own organizations) residing or employed in the Canal 
Zone, who can not produce satisfactory evidence of a successful vaccination within 
the past five years, shall, within the thirty days next ensuing, be vaccinated against 
smallpox. 

3. Every person required to be vaccinated should appear at a district dispensary 
for this purpose at the earliest opportunity within the specified time. There will be 
no charge for vaccination. The District Physician will direct the person vaccinated 
as to when to appear again at the dispensary for observation of the results of the 
vaccination. Upon visible proof of the fact that the vaccinated person has acquired 
immunity against smallpox, as evidenced by the reaction observed, the district physi- 
cian will sign and issue to such vaccinated person a CERTIFICATE OF VACCINA- 
TION showing the date of such vaccination and the reaction observed. 

4. While revaccination will not be enforced upon those who produce proof of a 
successful vaccination within the five years preceding this date, it is urged that all 
who have not had a successful vaccination quite recently submit to revaccination at 
this time in order to insure that their immunity is built up to the highest possible 
degree. 



30 

5. When employees are working or residing in isolated situations, where it would be 
greatly inconvenient for large groups of employees to report to the dispensary for 
vaccination, arrangements will be made, on request to the Chief Health Officer, for a 
vaccinator to be sent to the place of residence or employment for the purpose of 
vaccinating such persons. 

J. F. Siler, 
Chief Health Officer. 
Approved: 

J. L. Schley, 

Acting Governor. 



Balboa Heights, C. Z., September 13, 1929. 
Circular 205-1. 

(Superceding Circular 205). 

Smallpox Vaccination, 
types of reaction and their significance. 

1. When an individual is properly vaccinated with a potent vaccine the type of 
reaction which follows is dependent upon the presence or absence of protective sub- 
stances in the tissues of the individual. Any one of the following results may occur 
after vaccination and the interpretation of each is as indicated below: 

(a) Vaccinia (primary vaccinia). If an individual has never been immunized 
by an attack of smallpox or by previous vaccination, then the reaction will mani- 
fest itself as a primary vaccinia. On the third or fourth day after vaccination a 
papule appears at the site of vaccination; about the fifth day the papule becomes 
a vesicle; as the vesicle enlarges it becomes umbilicated and by the seventh day 
is surrounded by a red swollen area which gradually extends. The vesicle then 
turns yellowish, and the surrounding areola continues to spread, reaching the 
maximum about the ninth or tenth day. By the twelfth day the vesicle dries 
leaving a brownish crust, which forms an excellent protective covering and should 
not be removed. This type of reaction indicates that immunity has been con- 
ferred and will be recorded on official records as "vaccina." 

(b) Vaccinoid reaction (secondary vaccinia, accelerated reaction). If an individ- 
ual has had smallpox or a successful vaccination but has lost a considerable 
degree of the immunity acquired thereby, then the reaction following vaccination 
is less severe than primary vaccinia. In comparison with primary vaccinia the 
papule will appear earlier, the vesicle will be smaller, and the surrounding areola 
of redness will be much less extensive when the reaction reaches its maximum in- 
tensity, which will be between the fourth and the eighth day. This type of 
reaction indicates that immunity has been conferred and will be recorded on 
official records as "vaccinoid." 

(c) Immune reaction (immediate reaction). If an individual has had smallpox 
or a successful vaccination and still retains a very high degree of immunity, then 
the reaction following vaccination will be greatly accelerated. The reaction 
consists of an area of redness surrounding the scarification and attaining its 
greatest diameter between 12 and 60 hours after vaccination. A papule may 
appear. Usually the reaction reaches its maximum intensity in 24 or 36 hours. 



31 

There is no transition from papule to vesicle and no diffuse area of redness. The 
time of appearance is of paramount importance in deciding that a given reaction 
is one of immunity. This type of reaction is indicative of a high degree of immuni- 
ty to smallpox and will be recorded on official records as "immune reaction." 

(d) Unsuccessful vaccination. If there is no reaction, or if the papule and 
areola do not appear until 72 hours or more and there is no vesiculation, or if the 
reaction fails in any other respect to conform to one of the three types described 
above, then the vaccination is "unsuccessful" and will be so recorded on form 
8996-2. 

2. Either of the first two reactions builds up the immunity of the individual to the 
desired point; the third type of reaction indicates that immunity already existed; 
when any one of the three occurs the vaccination will be regarded as successful. 

3. If none of the first three reactions, (a), (b), or (c) above, occurs, the vaccination 
will be considered a failure, and revaccination will be performed at once either with 
new virus, if that previously used is suspected of being inert, or with improved tech- 
nique. It should be remembered that complete absence of any reaction is nearly 
always due either to an inert virus or to faulty inoculation. 

4. "Bad arms," large areas of necrosis, disfiguring scars, and other undesirable com- 
plications, are generally the result of faulty technique on the part of the vaccinator, 
being caused either by criss-cross scarification, too large an area of inoculation, or 
infection with certain pathogenic organisms. Vaccinia is usually more severe on the 
leg than on the arm. 

STORAGE AND SHIPMENT OF VACCINE. 

5. Smallpox vaccine loses its potency within a short period of time when exposed 
'to tropical temperatures. Consequently it will be stored in a refrigerating plant when 
one is available, the optimum temperature being about minus 10° C. If such a plant 
is not available it will be kept in a refrigerator contiguous to the ice. The amount 
of vaccine removed from cold storage at any one time will be limited to that required 
for immediate use. For shipment, vaccine will be packed in such a manner as to 
assure a continued low temperature while in transit. 

METHOD OF VACCINATING. 

6. The site of vaccination will be the insertion of the deltoid unless there is some 
valid reason for choosing another location. Vaccination will not be performed on 
the leg unless specially requested. 

7. The vaccine colony grows only in unbroken skin. When inoculated at the junc- 
ture of the dermis and epidermis it spreads outward into the unbroken skin, forming 
a vesicle around the site of inoculation. No advantage is gained from large areas of 
insertion, but a distinct disadvantage results from the considerable area of necrosis and slough 
which is apt to follow. 

8. When vaccination is to be done the required amount of virus will be removed 
from the refrigerator and placed in a small glass container surrounded by cracked ice 
in a large thermos bottle. In this manner it may be carried safely from house to house. 

9. The skin at the site selected for vaccination will be cleaned with alcohol or soap 
and sterile water and gently rubbed dry with sterile gauze; the alcohol must be allowed 
to evaporate completely. 

10. After evaporation of the alcohol, place a drop of vaccine virus upon the 
cleansed skin. To expel the virus from the glass capillary tube puncture the di?- 



32 

phragm of the rubber bulb by forcing one end of the glass tube through the rubber 
bulb from the constricted end until it is exposed through the aperture in the bulb 
at the other end; then break off this exposed end of the tube and draw the tube back 
into the bulb so that the broken end of tube is within the constricted portion of 
the bulb. Then break off other end of tube, and, closing the aperture in the bulb 
with the finger, expel the virus onto the cleansed skin by compressing the bulb. 

11. Multiple Puncture Method: Vaccination should never be performed by cross 
scratching. The following technique will be used: With the left hand, grasp the 
under surface of the arm in order to stretch the skin where the virus has been placed. 
With the right hand holding the new sterile needle parallel with the skin, make about 
fifteen oblique pricks or shallow punctures through the epidermis by pressing the 
point of the needle through the drop of virus. Confine the punctures to one area not 
more than one-eighth (1/8) of an inch in diameter. The motion should be firm enough 
to cause the needle point to enter the epidermis each time, producing a slight redness 
when the procedure is completed but no trace of serum or blood. 

Sufficient virus to produce a satisfactory "take" or vaccination will be carried 
beneath the superficial layers of epidermis by these multiple punctures. The surplus 
virus remaining on the surface of the skin may be gently wiped off with sterile gauze, 
using a single stoke. NO SHIELD or other dressing should be applied. The vacci- 
nation site should not be exposed to direct sunlight for four hours. 

12. No person will be vaccinated when he appears to be ill unless in emergency to 
protect against recent exposure to smallpox. 

RECORD OF VACCINATIONS. 

13. A Smallpox Vaccination Record (Form 8996) will be completed in case of each 
person vaccinated in the Canal Zone. In each case in which the history shows "old 
scar present," "previously vaccinated but no scar," or "has had smallpox," the vacci- 
nator will take the necessary steps to secure an examination of the vaccinated person 
on the 2d and 5th day after vaccination in order to observe the result. See Par. 1, 
(a), {b), (c), and (d). The results observed will be entered on the Smallpox Vaccina- 
tion Record in the space provided therefor. In cases recorded as "never vaccinated 
before" the observation of the result will be made on the 5th day. 

14. If the vaccination results in a reaction such as is described in Par. 1, (a), (b), or 
(c), the vaccinator will sign and deliver to the vaccinated person a SMALLPOX 
VACCINATION CERTIFICATE (Form 8978) which shall show the name of the 
person vaccinated and such other data as are indicated on that form. The completed 
Smallpox Vaccination Record (Form 8996) will be filed in a permanent manner, ar- 
ranged alphabetically, in the offices of district physicians, or other offices maintaining 
permanent records. If the vaccination results unsuccessfully, as described in Par. 
1, (d), the individual will be revaccinated at once. If the second vaccination 
results unsuccessfully, no further attempts will be made but Form 8996 will be 
completed by proper entries and forwarded to the Chief Health Officer. 

15. It is of distinct advantage to the Health Department as well as to the individual, 
that unnecessary revaccination be avoided, and it is consequently directed that all 
reasonable efforts be made by the vaccinator to secure an examination at the proper 
dates, or if this is impossible at approximately the proper dates. These steps should 
include the maintenance of a nominal list of vaccinations (the smallpox vaccination 
record card can be used for this purpose) and a daily checking of it, to determine 
whether or not the individuals are reporting as required. In the event that they do 



33 

not report voluntarily, efforts should be made to obtain their attendance by use of the 
telephone or other means. Each person vaccinated will be informed by the vaccina- 
tor that unless he reports back for observation, as prescribed in paragraph 13 above, 
the vaccination will be considered a failure and immediate revaccination will be 
required. 

FREQUENCY OF VACCINATION. 

16. Attention is invited to Board of Health Ordinance No. 5, approved January 16, 
1915, which requires that 

Every person living in the Canal Zone who has not been successfully vaccinated 
within five years, or who has not had an attack of smallpox (which facts shall be 
determined by the Chief Health Officer) shall submit to vaccination to the satis- 
faction of that officer unless, in his opinion, the person is not a fit subject for 
vaccination; and it shall be the duty of every person having the care, custody, 
or control of any minor or other individual over three months of age, to cause 
such minor or individual to be properly and effectively vaccinated. 

17. All persons arriving in a port of the Canal Zone and intending to reside in the 
Canal Zone or in the cities of Colon or Panama, Republic of Panama, for a period of 
two or more weeks, will be vaccinated on shipboard by the Quarantine Officer unless 
they present evidence of successful vaccination within a period of five years, as indi- 
cated by a certificate acceptable to the Health Department, or by a display of a scar 
or other lesion which is considered by the Health Department to indicate immunity 
to smallpox. 

18. Surgeons on steamships of the Panama Railroad Company, as soon as practi- 
cable after leaving New York, will vaccinate each passenger in whose case vaccination 
is a requisite for landing under the provisions of Paragraph 17. These surgeons will 
issue a Smallpox Vaccination Certificate (Form 8978) to those showing one of the 
reactions described in Paragraph 1 (a), (b), and (c), and in addtion will complete and 
mail to the Chief Health Officer a Smallpox Vaccination Record (Form 8996). 

19. This circular replaces previous instructions in Chief Health Officer's circular 
of October 23, 1918, and circulars numbered 47, 68, 150, 162-B, 175, 191 and 205, 
bearing on the same subject. 

J. F. Siler, 
Chief Health Officer. 

Approved: 

J. L. Schley, 

Acting Governor. 



Balboa Heights, C. Z., September 16, 1929. 
To All Steamship Company Agents: 

In view of the increased number of cases of smallpox in Panama during the past 
few days, and in order to obviate possible quarantine restrictions against the ports of 
The Panama Canal by other countries, the Health Department suggests that you 
rigidly enforce the following, during the present prevalence of the disease: 

Do not issue a ticket for any outgoing passenger unless he presents a certificate of 
successful vaccination issued or approved by a physician of The Panama Canal Health 
Department. 

MR 21831 3 



34 

Do not allow a transit passenger to go ashore in Panama unless he presents positive 
evidence of a successful vaccination within five (5) years, or is vaccinated on board 
before going ashore. 

Do not allow a member of the crew to go ashore unless he presents positive evidence 
of a successful vaccination just prior to the voyage he may then be on, or is vaccinated 
on board before going ashore. 

J. F. Siler, 
Chief Health Officer. 



Balboa Heights, C. Z., September 27, 1929. 
To All Concerned: 

1. Reference is made to the circular of September 13th, requiring smallpox vacci- 
nation within 30 days of every Canal and Railroad employee. 

2. Payroll lists will be sent out in the near future to heads of departments and divi- 
sions for use in connection with insuring compliance with the above requirement. 
These are to be turned over to gold supervisors or foremen, who will check the vacci- 
nation certificates (Form 8978 or other form of vaccination certificate bearing the writ- 
ten approval of a Health Department physician) presented by the employees under 
their supervision and indicate their vaccination status on the payroll lists. New em- 
ployees whose names do not appear on the list should be added thereto and their 
vaccination status shown. 

3. As stated in the circular of September 13th, employees who can not produce 
satisfactory evidence of a successful vaccination within the past five years must be 
vaccinated. In the case of those who present smallpox vaccination certificates de- 
scribed in paragraph 2 above, the foreman or gold supervisor should check their names 
on the payroll list thus: \J , making entry thereon also of the date on which the vacci- 
nation certificate was issued. If the employee is absent from the Isthmus or if he 
refuses to be vaccinated, a statement to that effect should be made following his 
name. The initials of the supervisor or foreman should appear on each sheet of the 
payroll lists checked by him. 

4. It is desired that the lists be checked and forwarded to this office as soon as 
possible, but in any event not later than October 14. If desired, they may be ac- 
companied by additional information with reference to any particular case. 

5. No one should be employed hereafter until he submits evidence of vaccination 
as above indicated or is exempted by the Chief Health Officer. 

By direction of the Acting Governor. 

C. A. McIlvaine, 
Executive Secretary. 

On September 13, nine mobile vaccinating units from the Panama 
City health office and five stationary units under the supervision of 
the health officer for the Republic of Panama began work in Panama 
City. Vaccination stations were also opened at the hospitals in 
Panama City, Red Cross headquarters, and at the health offices of 
Panama City and of the Republic of Panama. At the same time 
similar organizations began work in Colon. The practicing physicians 
in the terminal cities volunteered their services and several thousand 
individuals were vaccinated in offices, clinics, and private hospitals. 



35 

In the Canal Zone, the hospitals and dispensaries were available 
for the vaccination of Canal Zone residents. Immediate and whole- 
hearted cooperation of the public in responding to the vaccination 
program was forthcoming beyond most sanguine expectations. All 
of the units were swamped with applicants for vaccination. Within 
a period of seven days, approximately 50 per cent of the entire popu- 
lation had been vaccinated. After the initial rush, vaccination units, 
each consisting of one or more vaccinators, one or more assistants, 
and a member of the Panamanian police force, covered the cities 
block by block. 

During the period June 18, 1929 to October 31, 1929, a total of 
163,479 vaccinations were done in the Zone and in the terminal cities. 
It is probable that the results accomplished in this campaign ap- 
proached as nearly 100 per cent as in any general vaccination program 
of its scope anywhere in the same period of time. 

x\t the same time the health department of the Republic of Panama 
initiated a general vaccination campaign throughout the Republic. 
Vaccinating units were sent to all sections of the country, and large 
numbers of people were vaccinated. There is no doubt that the popu- 
lation of the Republic of Panama is at the present time more thoroughly 
protected against smallpox than at any time during its history. 
' There were 130,000 capillary tubes of vaccine ordered for health 
department use, 4,550 of which were sold to outside agencies. The 
cost of vaccine used by the health department amounted to $6,273.50. 

The amount expended by the Health Department of The Panama 
Canal for the vaccination program in the terminal cities and the Canal 
Zone amounted to $8,676.31, distributed as follows: 

Extra personnel....:...... . .. _._ $1,902.81 

Vaccine . ...'. 6,273.50 

Miscellaneous .. 500.00 

Total $8,676.31 

It is of interest to note that the total expenditure for vaccinations, 
exclusive of the salaries of regular health department personnel, who 
did this work in addition to their regular duties, was at the rate of 
5.3 cents for each person vaccinated. 

The more important observations made during the vaccination 
campaign were as follows: 

(a) The most interesting point was the extraordinarily whole- 
hearted cooperation and response to this vaccination program on 
the part of the population as a whole. 



36 

(b) Reactions occurred in practically 100 per cent of the indi- 
viduals vaccinated, vaccinoid reactions, resembling in many 
instances the typical vaccinia, being by far the most prevalent. 

(c) A negligible number of severe reactions occurred, either local 
or general. There were a few severe reactions but not a single 
instance was reported of a case which was considered serious. 
No complications suggestive in the slightest degree of encepha- 
litis lethargica were noted. 

(d) The fact was demonstrated that if at any time during a 
vaccination campaign there is a shortage of vaccine, one capillary 
tube of potent virus can be used to vaccinate six individuals. 
It was necessary to conserve vaccine during a part of the period 
and this was accomplished by using a smaller amount of vaccine 
per individual. When it is desired to follow this procedure, it is 
imperative to have the arms of all individuals prepared simul- 
taneously for the application of the vaccine, and then apply the 
virus to each of the six persons without removing the finger from 
the expression bulb of the tube. 

The excellent results obtained were attributed to: 

First: The favorable and explanatory newspaper publicity which 
aroused the population to the necessity for vaccination. (One of the 
local papers carried several pictures of patients actually sick with 
smallpox in Gorgas Hospital.) 

Second: The vaccine was of excellent quality and it was maintained 
at a low temperature from the time it was shipped from the biological 
laboratories in the United States until a few minutes before use. 
When taken out of refrigeration for distribution, it was transported 
by the individual vaccinating units in iced thermos jugs and kept in 
these jugs until ready for use. 

Third: Every effort was made to supervise adequately the work of 
the vaccination units. The vaccinators were carefully instructed in 
the technique to be followed and their actual work in the field was 
constantly supervised, and corrected if found to be faulty in any respect. 
The routine technique was as follows: 

Cleanse the area carefully with alcohol. 

Allow the alcohol to evaporate thoroughly. 

Place about one-third of the contents of a capillary tube on the arm. 

Inoculate by the multiple-puncture method, confining the puncture to a very 
small area. 

Gently remove any residue and instruct individual not to apply dressings of any 
kind. 

From the clinical point of view, the disease resembled that described 
by various authors as "alastrim" or "kaffir-pox." In the light of 



37 s 

observations made during the course of the epidemic the conclusion 
was reached that the disease should be classed as a mild smallpox 
which exhibits certain characteristic symptoms that differ from those 
of the severe form. The disease follows the course of mild smallpox 
in its general symptoms; patients are usually not very ill, or if so, only 
for a day or two. The mortality is extremely low, and in this series 
of cases the only death occurred from a complicating lobar pneumonia 
that developed when patient was well along in his convalescent period. 

The eruption seems to have certain characteristic lesions which 
involve the skin to a lesser degree than is usually observed in smallpox. 
Following desquamation no typical pox marks remain but pigment loss 
areas may be present for varying periods of time, which usually return 
to normal within a few months. 

Vaccination affords protection against the disease but the immunity 
seems slow in developing. A period of three weeks after a successful 
vaccination is believed necessary before any great degree of immunity 
is built up. In this series of cases, patients with smallpox were ad- 
mitted to the hospital showing vaccination results in all stages; 
numbers developed the disease after having been successfully vacci- 
nated within a period of three weeks, but there were very few who 
developed the disease after having been successfully vaccinated one to 
three months previously. Old successful vaccinations of three or more 
years did not always prevent an attack but seemingly did lessen its 
severity. 

The age incidence was shown to be greatest in the age group from 
1 to 10 years. There were 10 cases under 1 year of age and 3 cases 
between 60 and 70 years of age. 

HEALTH OFFICE OF THE CITY OF PANAMA. 
Dr. Paul Preble, Surgeon, U. S. P. H. S., Health Officer. 

Building inspections. — There were 1,120 building permits issued as 
follows : 

New buildings.... 119 

Repairs and alterations, including ventilation and rat-proofing 376 

Miscellaneous 509 

For installation and rat-proofing of bars, fixtures, and counters in business 

houses.. 116 

All such construction, alterations, repairs and installations were 
closely supervised to make sure that the required rat-proofing was 
properly done. 



38 

Milk and dairy inspections. — There were 26 dairies supplying milk 
to the city of Panama, a small part of the output being sent to the 
Canal Zone and to Colon. The dairy herds have a total of 2,105 
animals. All dairy animals were tested for tuberculosis; 17 were 
found to be reactors and were destroyed. 

Garbage disposal. — The garbage from the city of Panama, Ancon, 
Balboa, Fort Amador, and Quarry Heights, was disposed of by burial 
at the old dump in the Calidonia section of the city; 93,989 cubic yards 
of garbage were collected and buried at an approximate cost of $2.44 
per ton (3 cubic yards). 

Veterinary work. — At the municipal abattoir in Panama City 
14,562 cattle were slaughtered, -of which 37 were condemned as un- 
fit - for food on account of the following conditions: Ecchymoses 
and infiltrations, 14; congestion, 1; septicemia, 8; tuberculosis, 5; 
exhaustion, 3; gangrenous wounds, 2; pneumonia, 1; death from 
unknown cause, 2; and pyrexia; 1. 

Of 15,477 hogs slaughtered at the municipal abattoir, 821 were 
condemned as unfit for food on account of the following conditions: 
Exhaustion, 42; cysticercosis, 688; cholera, 73; pneumonia, 10; gan- 
grene, 1; septicemia, 3; ecchymoses and infiltrations, 4. 
7 Inspections were made of 10,352 cattle and 5,474 hogs shipped from 
the Pacific to the Atlantic side. Certificates were issued for 25,321 
hides derived either from animals slaughtered at the municipal 
abattoir, which had received ante and post-mortem examination, or 
from animals slaughtered in the interior, the hides from which were 
disinfected under the supervision of our veterinarians. 

Fines. — A total of $252 in fines was collected for violations of the 
sanitary rules and regulations. 

An epidemic of a mild form of smallpox occurred in the city from 
June to October. A full description of this epidemic, and the measures 
taken to control it, together with a history of the occurrence of that 
disease on the Isthmus of Panama during the past half century, 
appears elsewhere in this report. 

HEALTH OFFICE OF THE CITY OF COLON-CRISTOBAL. 
Dr. J. L. Bvrd, Health Officer. 

Smallpox. — When smallpox became epidemic in Panama City, from 
June to October, a vaccination campaign was instituted in order to 
prevent the spread of the disease to Colon. From September 12 to 
October 18, 40,023 vaccinations were performed in Colon and Cristobal. 



39 

Since the population of this district is approximately 40,000 we believe 
that the population of this community is now thoroughly protected 
against smallpox. 

Cristobal Woman's Club Free Clinic. — This clinic is operated for those 
who are unable to pay for medical attention. The work includes 
prenatal and postnatal cases, eye, ear, nose, and throat cases, dental 
cases, as well as a general clinic for babies and children under 6 years 
of age; food formulas are prepared for babies. Following is a report 
of cases treated during the year 1929: 

Babies and children under 6 3,328 

Prenatal and postnatal 533 

Dental... 21 

Eye, ear, nose, and throat... 953 

Feeding formulas for babies 6,019 

The health officer is director of the clinic. 

Infant mortality. — The infant mortality rates per 1,000 live births 
in the city of Colon for the past 8 years have been as follows: 

1922... 140 1926 129 

1923 116 1927.. 109 

1924 ", 1 14 1928. 104 

1925 117 1929 116 

• Building work. — Eighty plans for new buildings or major repairs 
were submitted and approved during the year, and 998 permits for 
repairs were issued. 

Garbage collection and disposal. — All garbage and rubbish from 
Colon and Cristobal, and garbage from France Field and Coco Solo 
are disposed of by burial. This system has proved satisfactory and is 
less costly than incineration. Fly breeding is controlled by the use of 
a mixture of 10 parts of crude oil, 2 parts of creosote, and 2 parts of 
kerosene. This mixture costs about 10 cents per gallon. The larvae 
of the Musca domestica and Stomoxys calcitrans are quickly killed with 
this mixture, but the larvae of Calliphoridae and Sarcophagidae are 
more resistant. However most of them are killed during the "hopper," 
or early adult stage, by the oil spray. The amount of garbage and 
rubbish collected and disposed of, and the cost of collection and 
disposal for the year, are estimated as follows: 

Collected by Health Department: 

Loads 18,630 

Cubic yards.... 65,205 

Tons 22,077 

(Note. — One load = 2,370 pounds = 3.5 cubic yards approximately.) 

Cost of collection, per load _ $1.78 

Cost of collection, per ton...: 1.50 



40 

Garbage and rubbish delivered to dump by other divisions, private trucks, 
carts, etc.: 

Loads 3,873 

Cubic yards 13,556 

Tons 4,589 

Total garbage and rubbish handled at dump: 

Loads 22,503 

Cubic yards 78,761 

Tons 26,666 

Cost of disposal, per load $0.61 

Cost of disposal, per ton .51 

Mount Hope cemetery. — There were 495 burials, the receipts from 
which amounted to $3,725. Sale of flowers amounted to $1,596.23, 
and miscellaneous receipts for special work done on graves, etc., 
were $165.35. 

Colon abattoir. — Ante and post-mortem inspections were made on 
4,716 cattle. Four carcasses were condemned, 2 on account of dying 
condition at time of slaughter, 1 because of septic infection, and 1 
because of extensive bruises. Twelve quarters were condemned on 
account of bruises and septic wounds, 329 livers because of parasitic 
infestation, and 8,335 pounds of meat because of bruises and septic 
condition. • 

There were 7,705 hogs inspected; 364 were condemned as unfit for 
food on account of the following conditions: Cysticercosis, 299; 
cholera, 23; emaciation, 10; pyemia, 25; heat exhaustion, 3; septicemia, 
1; icterus, 1; pleuritis, 1; dying condition, 1. 

Mount Hope {Panama Canal) abattoir. — Ante and post-mortem 
inspections were made on 8,769 cattle, 36 were condemned on account 
of the following conditions: Hemorrhagic septicemia, 7; dying con- 
dition, 6; emaciation, 10; actinomycosis, 1; extensive bruises, 6; 
pyemia, 1; septic wounds, 4; tuberculosis, 1. 

Two carcasses were found slightly infected with bovine cysticer- 
cosis, but were passed for food after retention in cold storage for a 
period of 30 days. Twenty-three quarters were condemned on account 
of bruises and septic wounds, 14 heads on account of actinomycosis, 
and 412 livers on account of parasitic infestation. 

Dairies. — Fourteen dairies located on the Atlantic side in the Canal 
Zone and the Republic of Panama produce about 2,000,000 pounds 
of milk annually. All this milk is pasteurized and bottled in 3 
modern plants, 2 of which are located in Colon, and 1 at Mount 
Hope in the Canal Zone. One of the pasteurizing plants was installed 
during the year with new milk-handling machinery, ice machine, and 



41 

cold storage room. A new pasteurizing machine with glass linings, 
a new milk cooler, and a complete automatic bottling machine were 
installed in the Panama Canal plant at Mount Hope, replacing old 
and out-of-date equipment. All dairies use small top milking pails. 
About 75 gallons of bulk pasteurized milk are received daily from 
Panama and bottled and sold in Colon. The tuberculin test was 
given to 1,006 dairy cattle; 5 cattle gave positive reactions and were 
slaughtered. 

General inspections. — Inspections of dairies, milk plants, bottling 
plants, ice cream plants, and venders, markets, restaurants, soft drink 
establishments, and grocery stores were made regularly. Investi- 
gations as to origin, soundness of quality, and sanitary conditions 
prior to and at time of purchase of meats, dairy products, and other 
foodstuffs were made, as well as frequent inspection of the places in 
which such articles were manufactured, handled, stored, and sold. 

Inspections were made as follows: Bakery, 283; dairy, 253; milk 
plant, 376; bottling plant, 109; ice cream plant and dealer, 445 ; market, 
522; restaurant, 1,016; milk dealer, 348. 

Meat, food, and food products condemned and destroyed as un- 
sound, unwholesome, or unfit for human consumption were as follows: 
Meat, 130,247 pounds; fish, 1,649 pounds; vegetables, 432 cans, 8 
barrels, 14 crates; cooked tinned boneless ham, 631 pounds; potted 
liver, 714 pounds; rabbits, 2,000 pounds; tripe, 300 pounds; casings, 
200 hanks; candy, 76 boxes, 288 bars; mangoes, 4 barrels; bananas, 
2 stems; canned pears, 19 cases; chickens, 3; coffee, 223 bags; cocoa, 
11 bags. 

Two hundred and eighteen samples of milk, meat, ice cream, soft 
drinks, and specimens of animal origin were sent to the Board of 
Health Laboratory for examination. 

Veterinary quarantine inspections. — Inspections were made of 383 
cows, 298 dogs, 12 horses, 18 sheep, 36 mules, 50 oxen, 2,000 steers, 
24 goats, and 151 circus animals. Certificates were issued for 13,581 
hides derived from animals which had been given ante and post- 
mortem inspection at Colon and Mount Hope abattoirs. 

DIVISION OF QUARANTINE. 

Dr. M. Flint Haralson, Surgeon, U. S. P. H. S., 
Chief Quarantine Officer. 

The Division of Quarantine operates two boarding stations, one at 
each terminus of the Canal. Quarters are available at the Balboa 
station for the normal detention and care of about 400 persons. One 



42 

building:, with a capacity for 92 people, is reserved for the use of cabin 
passengers; this building is divided into rooms, each of which accom- 
modates 4 persons. The other buildings, of the barracks type, are 
for the use of steerage passengers and members of crews of vessels. 
Four medical officers and one quarantine inspector are on duty at each 
of the boarding stations, together with a sufficient number of colored 
personnel to perform the necessary work, including fumigation. 

The only change in routine quarantine procedure during the year 
was the initiation of quarantine inspection of commercial airplanes. 
Three air transport lines have now inaugurated services to the Canal 
Zone. The first arriving airplane was inspected on February 6, 1929. 
During the succeeding months the service was gradually increased, 
and a total of 246 planes was given quarantine inspection by the end 
of the year. At present a thrice-a-week schedule is maintained from 
both North and South. 

Routine inspection of arriving vessels was maintained to prevent 
the entrance of any quarantinable disease into the Canal Zone. Partic- 
ular attention was given to vessels arriving from plague-infected 
ports. It is felt that, of all quarantinable diseases, the entrance of 
plague into the Canal Zone is the greatest potential menace. All 
vessels docking at Canal Zone ports are required to breast-off four feet- 
from the piers and to be properly rat-guarded at all times. The 
building regulations of the Canal Zone and of Panama and Colon 
require that every structure be built to afford a minimum of harborage 
for rats. 

No vessels were detained on account of the presence of a quaran- 
tinable disease on board. One vessel for transit (an Army transport) 
arrived at Cristobal with 2 cases of meningitis among the troop 
class. The 2 cases were removed to the hospital, while the passen- 
gers destined for the Canal Zone were allowed to land but were held 
under observation for a period of 7 days. The 149 members of 
crew and the remaining 712 passengers were held on board the ship, 
which continued on her voyage to ' San Francisco without further 
quarantine procedure. 

An epidemic of a mild form of smallpox made its appearance in 
Panama City during the month of June, and it became necessary to 
adopt measures for outgoing vessels leaving Canal Zone ports to 
protect them from possible quarantine restrictions upon arrival 
in foreign ports. Vaccination against smallpox was enforced strictly. 
All persons boarding vessels at Canal Zone ports, all passengers who 
came ashore at either of the ports, and all members of the crews of 
such vessels, were vaccinated during the period of the epidemic. The 



43 

epidemic was of local origin having been brought to Panama City 
from the interior of the Republic. There was a total of 389 cases 
reported during the epidemic; 339 from Panama City, 23 from Colon, 
22 from the Republic of Panama, and 5 cases from the Canal Zone. 

The quarantine station at Balboa was utilized for the detention of 
131 smallpox convalescent patients after their discharge from Gorgas 
Hospital where all cases were treated. This group was cared for and 
maintained for a total of 1,749 detention days. 

Inspection of vessels was performed promptly and efficiently, and 
shipping expedited as much as possible. The regular hours for board- 
ing vessels at Canal Zone ports are extremely liberal, extending from 
sunrise to 10 p. m. From January 2 to June 13, boarding hours were 
maintained during the whole of the 24 hours of each day. This was 
necessary on account of the periodic overhaul of the locks at the Pacific 
entrance of the Canal, which allowed but one set of locks to used at a 
time. 

Practically all fumigation of vessels during the year was done with 
Zyklon B. The use of this fumigant has continued to prove very 
satisfactory and has resulted in the saving of both time and expense 
to maritime commerce and The Panama Canal. 

The Division of Quarantine continues to supervise the fumigation 
of animal foodstuffs imported from regions of South America, where 
foot and mouth disease of cattle prevails. During the year, 153 box- 
car loads of such animal foods were fumigated with formalin. 

Officers of the division are also the immigration officials for the 
Panama Canal. The division cooperates with the immigration service 
of the Republic of Panama in the enforcement of their immigration 
laws, and quarantine officers perform this additional duty. Since 
Balboa and Cristobal are the principal ports of entry for the Republic 
of Panama, practically all individuals destined for Panama enter at 
one of these ports. All persons who, in the opinion of the quarantine 
officers, possess the necessary credentials are allowed to enter Panama 
without further formality. Those who have not complied with all the 
provisions of the Panamanian immigration laws are detained tempo- 
rarily and referred to the Panamanian authorities for final disposition. 
The immigration activity which the division performs is becoming 
more and more time-consuming in view of the increasing number of 
tourists and visitors who come to the Canal Zone and the Republic of 
Panama. During the year, 1,066 persons were detained at the Balboa 
station under the provisions of the immigration laws for a total of 9,598 
detention days. 



44 



During the year the Chief Quarantine Officer visited the principal 
South American ports on the west coast as far as Valparaiso, where 
sanitary conditions were observed. 

The activities of the Division of Quarantine for the year are sum- 
marized as follows: 



Vessels inspected and passed 

Airplanes inspected and passed 

Vessels granted pratique by radio 

Vessels passed on certificates of masters . 
Vessels issued provisional pratique 



Total . 



Crew inspected and passed 

Crew passed by radio 

Crew passed on certificates of masters 

Passengers inspected and passed 

Passengers passed by radio 

Passengers passed on certificates of masters. 

Total 



Vessels detained in quarantine 

Supplementary inspection of vessels. 

Vessels fumigated 

Rats recovered after fumigation . . . . 
Box cars fumigated 



Crew detained in quarantine on board ship 

Passengers detained in quarantine on board ship 

Persons admitted to station account of immigration laws . 

Number of detention days for month 

Persons held or detained for investigation and released. . . 
Persons deported under immigration laws 



Persons vaccinated . 



Rations issued: 

Cabin passengers 

Steerage passengers (including smallpox convalescents). 

Gold employees 

Silver employees 



Total. 



Balboa. 



1,084 
21 



2,129 




3,322 



51,780 
29,340 
110,674 
18,488 
446 
28,660 



239,388 





920 

39 

82 

103 






1,066 

9,598 

48 

371 



3,053 



392 

11,605 

1,240 

5,732 



18,969 



Cristobal. 



1,981 
225 
101 

2,203 

1 



4,511 



148,330 
20,974 
95,189 
88,066 
2,079 
12,768 



371,455 





3,917 

81 

387 

51 



Total. 



,065 
246 
189 

,332 
1 



7,833 



200,110 
50,314 
205,863 
106,554 
2,525 
41,428 

610,843 





4,837 

110 

469 

154 



149 

712 





74 

654 



149 

712 

1,066 

9,598 

122 

1,025 



7,406 



392 
11,605 
1,240 
5,732 



18,969 



Total cost ofrations 87,286.64 

Average daily cost, each ration .384 

GORGAS HOSPITAL. 

(Capacity 800 patients.) 
Col. Geo. M . Ekwurzel, Medical Corps, U. S. Army, Superintendent. 

Administration. — For many years the hospital admitting office was 
combined with the dispensary serving the district of Ancon. Because, 
of the distance of the dispensary from the hospital proper, together 
with continued increase of hospital population, it became necessary to 
bring the admitting office closer to the other hospital units. This was 
effected in the month of November by providing space for an admitting 
office and emergency station on the ground floor of the administration- 
clinics buildings. At the same time Ancon dispensary, in charge of a 
district physician, was made an independent unit reporting directly 
to the Chief Health Officer. 



45 

Buildings and equipment. — The remodeling of ward 4, section "A," 
to provide 14 additional private rooms was completed in April. Each 
room was finished in a different color scheme and the rooms were 
furnished with all-steel hospital beds and furniture. The total cost 
of these improvements was approximately $30,000. 

The increase in nursing staff, necessitated by increase of hospital 
population, required additional housing facilities for nurses. In 
October was begun the work of construction of an addition to the 
nurses' quarters at an estimated cost of about $90,000. This addition, 
which will be completed and occupied in 1930, will contain 28 bedrooms, 
a tea room, a card room, a reception room, and a small kitchen, and 
will enable the hospital to quarter satisfactorily a total of 100 female 
nurses. 

Climatic conditions alone require considerable work to prevent 
deterioration of buildings and equipment. The routine work of 
maintenance and repair thereof, including repainting of rooms and 
furniture throughout the hospital, and the repair of all elevators, was 
done by the hospital artisans. In addition, a large amount of new 
work was completed and many articles of furniture and equipment 
manufactured for the hospital and other units of the Health Depart- 
ment. 

Surgical service. — There were 2,019 major operations (with 26deaths), 
1,911 minor operations (with 1 death), and 4,258 intravenous injections 
of arsphenamin (with 1 death); 7,626 cases visited the out-patient 
department; 446 obstetrical cases were delivered, in which there were 
8 twin births and 30 stillbirths. Medical service. — There were 8,849 
cases treated in the out-patient department, of whom 1,610 were not 
connected with The Panama Canal or the Panama Railroad, or other 
U. S. Government services. Dental service. — There were 3,758 sittings 
during the year; 1,252 oral examinations; 829 teeth extracted; 498 
complete and 554 partial dental X-ray examinations were made during 
the year. Eye, ear, nose, and throat service. — There were 14,643 visits 
to the out-patient department, 2,485 operations performed, and 1,395 
refractions were made. Radiographic service. — There were 5,479 cases 
handled for which 14,889 films of various sizes were used and in which 
861 fluoroscopic examinations were made. Physio-therapy service. — 
Eleven hundred and eighty-one out-patients and 931 in-patients received 
treatments in this clinic during the year. Nonresidents — Six hundred 
and ninety patients, whose residences were outside of the Canal Zone 
or the cities of Panama and Colon, were treated in Gorgas Hospital 
during the year. 



46 



SURGICAL SERVICE. REPORT OF OPERATIONS. 



Amputations: 

Arm 

Forearm 

Thigh 

Leg 

Foot 

Digits, multiple 

Operations on bones: 

Craniectomy, decompressive 

Ostiectomy '. 

Wiring, simple fracture 

Plating, simple fracture 

Plating, compound fracture 

Reduction of fracture, simple 

Reduction of fracture, compound 

Bone graft 

Adenectomy: 

Cervical 

Axillary. 

Inguinal, single 

Inguinal, double 

Femoral 

Strangulated 

Herniotomy: 

Inguinal, single 

Inguinal, double 

Femoral 

Ventral 

Strangulated 

Genito-Urinary tract: 

Nephrotomy 

Nephrectomy 

Nephropexy 

Cystotomy 

Urethrotomy, internal 

Urethrotomy, external 

Prostatectomy 

Varicocele, radical cure 

Hydrocele, single, radical cure 

Hydrocele, double, radical cure 

Orchidectomy 

Vasectomy 

Amputation of scrotum 

Curettage uteri 

Perineoplasty 

Trachelorrhaphy 

Vaginal puncture 

Epididymotomy 

Obstetrical : 

Cesarean section, abdominal 

High forceps 

Low forceps 

Version 

Thorax: 

Thoracotomy 

Excision of breast 

Excision of breast and axilla 

Rectum: 

Hemorrhoids, radical cure for 

Fistula in ano, excision of 

General: 

Thyroidectomy 

Stab wound soft parts, operation for. . 

Congenital defect, plastic operation for 

Effects of disease, plastic operation for 

Skin graft 

Varicose veins, excision of 

Laparotomy: 

For general peritonitis 

For intestinal obstruction 

Exploratory 

Gastrotemy 

Gastroenterostomy 

Gastrectomy 

Gastrectomy (subtotal) 

Entsro-enterostomy 

Ent°rectomy 

Enterorrhaphy 



Number. 


Died. 


1 




2 




3 




2 




1 




1 




1 




9 




2 




6 




2 




96 




3 
1 


1 






1 




161 




4 




14 




1 




118 




21 




3 




12 


• 


4 




1 




3 




1 




7 
45 


1 


14 




4 
6 


1 


23 




4 




4 




1 




1 




410 




23 




10 




14 




83 




10 
1 


1 


9 




2 




7 
2 


1 


3 




126 




4 




8 
1 


I 


2 




13 




3 




8 




1 

1 

22 

1 


1 

1 
3 


6 




1 
1 


1 


3 
2 
4 


2 
1 



47 



SURGICAL SERVICE. REPORT OF OPERATIONS-Continued. 



Laparotomy — Continued: 

Appendectomy 

Appendectomy with local peritonitis. . . 

Appendectomy with general peritonitis. 

Calcostomy 

Cholecystectomy 

Cholecystotomy 

Cholecystectomy 

Choledochectomy 

Abscess of liver, laparo-hepatotomy for. 

Abscess of liver, thoracc-hepatotomy f or 

Splenectomy 

Pan-hesterectomy 

Supravaginal hysterectomy , 

Hysteromyomectomy 

Myomectomy 

Salpingectomy, single 

Salpingostomy, single 

Salpingostomy, double 

Salpingo-oophorectomy 

Ovarian cystostomy 

'Oophorectomy 

Suspensio uteri. 

For ectopic gestation 

For trauma (hemoparitoneum) 

Major operations, various other 

Minor operations, various 

• Circumcision 

Cautery. 

Novarsenobenzol 

Blood transfusion 

Summary: 

Major operations 

Minor operations 

Administration of Novarsenobenzol. . . . 





Number. 


Died 




256 

27 

4 

1 

13 

1 

12 

3 

3 

1 

1 

15 

99 

33 

1 

5 

14 

3 

24 

2 

19 

96 

3 

1 

11 

1,621 

257 

31 

4,258 

2 






1 




2 








1 




























2 




1 




1 




































1 




1 




2 




1 












1 












2,019 
1,911 

4,258 


26 




1 




1 



EYE, EAR, NOSE, AND THROAT SERVICE. REPORT OF OPERATIONS. 



Eye: 

Advancement 

Cataract, linear 

Cataract, simple 

Cataract, combined 

Chalazion, removal 

Conjunctival flap 

Enucleation 

Foreign body, removal of .. . . 

Hordeolum, incision of 

Iridectomy 

Lachrymal operations 

Dilation of ducts 

Plastic operation on lid 

Needling '. 

Pterygium 

Tenotomy 

Trephine, scleral 

Various other eye operations. 
Ear: 

Furuncle, incision of 

Foreign body, removal of 

Mastoid, simple 

Mastoid, radical 

Paracentesis 

Polypi, removal of 

Sebaceous cyst 

Minor ear operations 

Nose: 

Cauterization 

Foreign body, removal of . . . . 

Plastic 



5 

1 

5 

36 

13 

4 

52 

4 
1 
6 

4 
22 
56 
4 
6 
IS 



Nose — Continued: 

Polypi, removal of 11 

Rhinoplasty 5 

Sinus, ethmoid, simple 7 

Sinus, frontal, simple 12 

Sinus, maxillary, simple 4 

Sinus, maxillary, puncture and drainage. . . 76 

Sinus, sphenoid, simple 1 

Reduction of fracture 2 

Spur removal 1 

Submucous resection 120 

Turbinectomy 13 

Minor nose operations 6 

Pharynx: 

Adenoidectomy 555 

Peritonsillar abscess, incision for 47 

Retropharyngeal abscess, incision 1 

Tonsillectomy 1 , 244 

Various other operations 4 

Minor operations 8 

Trachea: 

Tracheotomy 3 

Tracheobronchoscopy 2 

Intubation 1 

Larynx: 

Laryngoscopy 1 

Other miscellaneous operations 6 

Total 2,485 

Refractions 1 ,395 



48 



X-RAY SERVICE. REPORT OF ACTIVITIES. 
Total number of cases handled 5 , 470 Nature of examination — Continued: 



Nature of examination: 

Ankle 157 

Abdomen 27 

Chest 1,871 

Colon 31 

Elbow 63 

Femur 82 

Fluoroscopic 861 

Foot 185 

Forearm 100 

Foreign 4 

Gallbladder 166 

G.I. Series 424 

Gastrio 9 

Genito-urinary tract 265 

Hand 211 

Hip 65 

Humerus 42 



77 

146 

148 

2 

101 

7 

16 
58 
136 

Sinuses 304 

Skull 161 

Spine 162 

Wrist 109 

Face 4 

Classification of films used: 

8x10 '. 3,300 

10x12 5,486 

14x17 6,103 



Jaw. 

Knee 

Leg 

Localization . 

Mastoid 

Neck 

Esophagus . . . 

Pelvis 

Shoulder . 



PHYSIO-THERAPHY SERVICE. REPORT OF ACTIVITIES. 



Radium: 

Hospital patients 

Outpatients 

Number of treatments 

Classification of diseases — 

Malignant 38 

Nonmalignant 150 

Roentgen therapy: 

Hospital patients 

Outpatients 

Number of treatments 

Classification of diseases — 

Malignant 76 

Nonmalignant 379 

Physio-therapy: 

Hospital patients 

Outpatients 

Number of treatments 4,096 

Classification of diseases — 

Skin 246 

Neurological 145 

Muscular 60 

Tuberculosis 27 

Other conditions 166 

Hydrotherapy: 

Hospital patients 

Outpatients 



55 
133 
295 



113 

322 

4S4 



293 

351 



225 

278 



Hydrotherapy — Continued: 

Number of treatments 3 , 658 

Classification of diseases — 

Joints 128 

Neurological 115 

Muscular 44 

Obesity 45 

Other conditions 143 . 

Phototherapy: 

Hospital patients 129 

Outpatients '. 33 

Number of treatments 1,451 

Classification of diseases — 

Joints 63 

Muscular 59 

Other conditions 40 

Massage: 

Hospital patients 

Outpatients 

Number of treatments 

Electric baking: 

Hospital patients 

Outpatients 

Number of treatments 

Classification of diseases — 

Joints 65 

Muscular 6 

Other conditions 5 



uti 
44 
724 

56 

20 

728 



DENTAL SERVICE. REPORT OF ACTIVITIES. 



Total number of sittings 3,758 

Abscess, periapical 175 

Abscess 12 

Abscesslanced 44 

Calculus 73 

Calculus removed 76 

Caries 285 

Curettage 4 

Devitalization and removal of pulp . 6 

Fractured mandible 12 

Fractured mandible, wiring of 12 

Fractured mandible, removal of ... . 2 

Fractured mandible, treatments. . . . 372 

Gingivitis 45 

Gingivae treated 290 

Gingivae lanced 13 

Oral examination, clinic 1,252 

Oral survey, clinic 55 

Oral examination, ward 92 

Oral prophylaxis 77 

Periodontoelatia 69 

Postoperative treatments 223 

Stomatitis, Vincent's 29 

Smears to laboratory 77 



Teeth: 

Extractions 

Impacted 

Treated 

Sockets packed 

Erupting 

Anesthesia: 

Conductive 

Ethyl chloride 

General 

Infiltrative 

Filling: 

Amalgam. 

Amalgam-cement 

Cement 

Gutta-percha 

Porcelain 

Root canal 

Dental X-ray: 

Complete 498 

Partial 554 

Interpretations.. 383 



829 



78 

2 

6 

158 

17 
23 
95 
10 
30 
4 



49 



REPORT OF OUT-PATIENT SERVICES. 



Medical service 

Surgical service 

Eye, ear, nose and throat service 

Physiotherapy service 

X-ray clinic 

Total 



Total 
visits. 



8,849 
7,626 
14,643 
4,624 
1,434 



37,176 



New 
cases. 



2,164 
2,119 
3,117 
468 
1,188 



9,056 



Pay 

cases. 



1,610 
406 

2,001 
136 
146 



4,299 



COROZAL HOSPITAL. 

(Capacity, 615 patients). 
Maj. Sidney L. Chappell, Medical Corps, U.S. Army, Superintendent. 

Purpose. — This institution cares for the insane of the Canal Zone 
and of the Republic of Panama, being reimbursed for the latter class 
of patients by the Republic at the fixed rate of $0.75 per day. It also 
cares for alien employees of the Canal Zone disabled by reason of in- 
juries or chronic diseases who desire to enter the institution. 

Repairs and alterations. — A wide concrete approach for trucks to 
unloading platform at kitchen, as well as sidewalks leading to this 
building were laid. Concrete sidewalks between wards "H" and "I" 
were also laid. A calf shed large enough to house 30 or 40 calves 
was constructed in close proximity to the dairy barn by hospital 
'artisans. The roofs of new laundry building and boiler house, and cor- 
ridors connecting kitchen with ward buildings, were painted and 
sanded. Two sets of wrought-iron gates were installed at front and 
rear entrances to hospital grounds. Also a pair of old French gates, re- 
moved some years ago from Gorgas Hospital, was set up after some 
alterations at the entrance to ward "K." The hospital road was 
repaired and widened by the Municipal Engineering Division. Routine 
painting and repairs to woodwork, plumbing, steam line, etc., have 
been made by hospital artisans, with the help of patients. 

Insane patients. — The census of December 31, 1929, was 608, an 
increase of 62 over that at the end of the previous year. The number 
admitted was 269, as compared with 266 for 1928. There were 158 
discharges and 45 deaths during the year. There were no suicides or 
deaths due to violence or altercations. Of the 158 discharged, 19 were 
considered as cured, 113 as improved, 26 as unimproved; 76 of those 
released were repatriated. Eleven patients were transferred to Gorgas 
Hospital for treatment; 7 of these were returned to Corozal, 1 died, 
and 3 were discharged from Gorgas Hospital. Of the new admissions, 
126 were cases paid for by the Government of Panama, and the 
remainder were Canal Zone charity cases or private pay patients. 



MR 21831 4 



50 

Other patients. — There were on December 31, 45 black and 4 white 
chronically ill or crippled inmates (not insane), as compared with 43 
black and 3 white of these classes at the beginning of the year. Six- 
teen were admitted, 3 died, 2 discharged, and 1 was deported. One 
was transferred to insane status. Sixteen were transferred to Gorgas 
Hospital for treatment, and of these, 10 were returned to Corozal 
Hospital, 3 died while in Gorgas Hospital, and 3 remained under treat- 
ment at Gorgas Hospital at the end of the year. All those capable of 
performing work were encouraged to do so. Sixteen were carried on 
the payrolls, employed as broom and brush makers, bandage rollers, 
ward attendants, janitor, laborers, and helpers. Approximately 235 
brooms per week were manufactured. 

Recreation. — Weekly picture shows and band concerts have been 
continued, and the patients derive considerable pleasure from these 
entertainments. Picnics were held twice a month, during the dry 
season in a grove back of the hospital, and during the rainy season in 
the basement of the new ward building; lunches are served, and base- 
ball, handball, and other games are played on these occasions. Church 
services were held weekly for the Catholic and Protestant patients. 
The former are held in the chapel near entrance to hospital road, and 
the latter are conducted in the basement of the new ward building. 

Treatment. — Intensive specific treatment was given to patients 
suffering from syphilitic psychoses. Eight hundred and seventeen 
doses of arsphenamin were administered intravenously, and 267 
lumbar punctures were made. At the end of the year there were 107 
patients suffering from neuro-syphilis or tertiary syphilis in some 
form, 71 of these were male and 36 female. 

Occupational therapy. — On December 31, 1929, there were 16 male 
and 30 female patients under treatment in the occupational therapy 
department. The men were taught carpentry, weaving, bag-making, 
rush-work, etc. ; the women were taught to make rugs and baskets, to 
sew, knit, embroider, crochet, and do rush-work. The articles pro- 
duced and sold were 142 rugs, 98 bags, 171 ornamental baskets, 123 
card-table covers, doilies and other embroidered pieces, 571 raffia purses? 
320 pieces of furniture, 14 boats in bottles, 42 knitted bags, and 22 
pieces of rush-work; 30 pieces of furniture were painted and repaired. 

In addition to the patients engaged in various lines of work in the 
occupational ward, other male insane who were strong physically 
but could not be accommodated in the occupational ward on account 
of limited space, were sent to the fields and employed in agricultural 
activities. The value of the produce from the patients' garden for 
hospital consumption amounted to $2,366.79. The more vigorous 



51 

females were assigned to tasks in the laundry, sewing room, or in the 
salvage department. As a result of these various undertakings, 
between 75 and 80 per cent of the patients were engaged in some form 
of work. All of the laundering, with the exception of bed sheets, 
pillowcases, and nurses' uniforms, was done by the patients. 

The total sales from the occupational ward amounted to $2,468.57, 
and from the brooms and brushes manufactured by the "chronics," 
$4,897.85, a total of $7,366.42. This money is utilized for material 
required to continue activites in these departments, and for tobacco, 
confections, fruit, refreshments, etc., for the patients. 

Dairy and farm. — There were 27 cripples employed on the farm at 
the close of the year, as compared with 29 at the beginning of the year. 
During this period 5 were transferred to Gorgas Hospital for treatment, 
all of whom returned; 1 was deported, and 1 discharged. These men 
are employed in the garden, dairy, piggery, steam plant, cemetery, 
etc. Five are tending plots of land in the farm reservation, which they 
cultivate as truck gardens and are paid on an actual production basis. 
Their average earnings per month amounted to $45.57. Subsistence 
was furnished them free of charge. The receipts for produce sold 
aggregated $3,546.41, and for manure $635.85. 

In February, 20 cows were purchased in Louisiana and added to the 
dairy herd. Two bulls were bought from Mindi Dairy. During the 
year, 4 heifers calved and became milk producers. Two cows died, and 
14 were butchered. At the end of the year the herd consisted of 89 
cows, 11 heifers, 53 calves, and 4 bulls. There were 158,058| 
quarts of milk produced, and milk sales during the year amounted 
to $34,772.87. 

There were 86 pigs, 21 hogs, and 3 boars on hand December 31, 1929. 
This section of the farm has again been restored as a source of revenue, 
net earnings for the year amounting to $2,167.31, gross revenue 
$4,392.46. 

Due to the steady increase in number of patients treated and the 
additional work resulting therefrom the number of gold employees 
was increased by the appointment of 1 additional male nurse, 1 
female nurse, and 1 clerk. 

It is expected that a new building to replace some of the obsolete 
male ward buildings will soon be authorized, and that actual work 
upon the construction of the building will be started about November 
1, 1930. This building, upon completion, will assist greatly in relief of 
ward congestion, facilitate caring for patients, improve living con- 
ditions, and eliminate a serious fire hazard. 



52 



COROZAL HOSPITAL COMMITMENTS AND DISCHARGES, 1929. 

COMMITMENTS. 





Insane patients only. 


From Canal Zone. 


From Panama. 


Total. 




Male. 


Female. 


Male. 


Female. 




105 
1 


23 
2 
1 


60 
4 
3 


47 
2 

1 

1 


235 




9 




4 






1 










1 














Total 


106 


26 


67 


51 


250 







DISCHARGES. 





Insane patients only. 


Male. 


Female. 


Total. 


Well 


19 

84 
19 




19 




13 

7 


97 




26 








Total 


122 


20 


142 







COLON HOSPITAL. 

(Capacity, 100 patients). 

Maj. Hertel P. Makel, Medical Corps, U. S. Army, Superintendent. 

Colon Hospital, although operated to some extent as an emergency 
hospital, has functioned during the past year as a small general 
hospital, giving definitive treatment in all types of cases except 
venereal and infectious diseases. 

During the past year the bed capacity has been increased to 1 10 beds, 
5 cribs, and 12 bassinetts. This increase has been made possible by 
making numerous alterations and improvements, as follows: (a) 
Building of new storeroom in basement of old storeroom which now 
offers enought space for all supplies, (b) Establishment of 2 iso- 
lation rooms, one of 3 beds and another of 2 beds, by conversion 
of 2 small former storerooms, (c) Establishment of new linen room 
in a concrete room in rear of hospital previously used for stores, (d) 
Removal of dining rooms from second floor to first into rooms formerly 
used as commissary and linen room. This move increased the bed 
capacity of ward E by 16 beds, (e) Removal of diet kitchen of ward C 
to unused porch space giving a better lighted, better ventilated, and 
more spacious diet kitchen. This move enabled us to establish a 
children's section in ward C. (/) Sun porch of ward C glassed in and 
a 6-bed ward established, (g) Enlargement of ward C nursery (white), 
giving more space for the care of the new born, (h) Establishment of a 
nursery for colored new born, (i) The dispensary clinics have been 
rearranged to offer better facilities for handling all classes of patients. 



53 

This necessitated cutting in new doorways, establishing separate 
waiting rooms, separate examining rooms, etc. 

In October an eye, ear, nose, and throat clinic was established and is 
now functioning. A new laboratory was established giving the hospital 
a better equipped and more spacious laboratory. 

Personnel. — The full complement of personnel on permanent duty 
was as follows: 1 superintendent, 6 physicians, 14 nurses, 1 laboratory 
technician, 1 chief clerk, 1 stenographer, 1 pharmacist, 1 storekeeper, 
23 orderlies, 3 helpers, 10 maids, 1 carpenter, 1 painter, 2 ambulance 
drivers, 1 cook, 1 assistant cook, 1 waiter, 1 assistant waiter, and 2 
kitchen orderlies. Total: 25 gold employees and 47 silver employees. 

Movement of the sick. — There were 61 patients in the hospital on 
January 1, 1929. There were 3,280 admissions during the year, with a 
total of 30,748 patient days, making an average of 9.37 days spent in 
hospital per patient. There were 46,789 visits to the dispensary, and 
351 house and ship calls. 

Hospitalization. — The average number of beds occupied during each 
month of the year was as follows: 

January 64.5 July 84.4 

February.... 65.8 August 88.7 

March 70.9 September.. 90.4 

April 82.0 October 93.8 

May 84.8 November... 100.4 

June - 81.4 December 99.5 

Medical service. — Four cases of blackwater fever were treated, none 
of whom were residents of the Canal Zone or Colon. The policy of 
transferring certain severe cases to Gorgas Hospital was discontinued, 
as it was believed the cases had a better chance of recovery if not 
forced to submit to the 50 miles of travel necessary to reach that 
institution. 

Surgical service. — The surgical service was more active than formerly. 
There were 424 major operations, 728 minor operations, and 144 
fractures were given definitive treatment. Although this hospital 
does not treat cases of venereal disease a salvarsan clinic is maintained 
by the surgical service. During the year, 1,018 treatments were given 
in this clinic. Of interest in the service was the adoption of the tannic 
acid treatment for burns. This treatment is believed to have reduced 
the days lost in hospital to one-half the time lost under previous 
methods of treatment. There were 12 fractures of skull; all of these 
were treated conservatively and all recovered. 

Obstetrical service. — There was a marked increase in the number of 
children born. A total of 420 babies was delivered, of whom 9 were 



54 

delivered by Caesarian section. In one case a Porro operation was 
performed with excellent results to mother and child. 

Rye, ear, nose, and throat service. — This service was established 
during the latter part of October. There were 52 operations for 
various conditions, 1,444 clinic treatments, and 71 refractions. 

X-ray. — The X-ray facilities of this hospital are limited, there 
being but a small portable unit available for this work. There were 
1,131 films for fracture and 154 complete dental surveys taken during 
the year. 

Laboratory. — The laboratory of this hospital functions as a clinical 
laboratory, the more highly specialized work being sent to the Board 
of Health Laboratory operated at Ancon. The work during the year 
totaled 12,278 examinations of various specimens of stools, urines, 
sputums, bloods, gastric contents, and other routine specimens. 

PALO SECO LEPER COLONY. 
Dr. Ezra Hurwitz, Superintendent. 

On December 31, 1929, there were 97 patients in the colony; 23 
were Canal Zone charity cases, and 74 Panama pay cases; there were 
27 women and 70 men. Classified according to nativity they were: 

From Republic of Panama: Chiriqui 2, Code 5, Colon 4, Los Santos 13, Pana- 
ma 20, Taboga 5, Veraguas 1, total 50. 

From West Indies: Antigua 1, Barbados 12, Grenada 2, Haiti 2, Jamaica 12, 
Martinique 3, St. Lucia 6, Trinidad 1, total 39. 

From other countries: China 1, Colombia 5. Costa Rica 2, total 8. 

During the year 8 patients were admitted, 9 were paroled, and 5 
died. The average number in the colony was 99.46. 

Four of the deaths were recorded as due to leprosy, in accordance 
with the preference of the Manual of Joint Causes of Death, 2d edition, 
1925, of the Bureau of the Census; one death was due to suicide by 
hanging. The immediate causes of death, as found at autopsy (re- 
corded as "contributory cause") were as shown in the report of the 
Board of Health Laboratory on page 63. 

The 9 patients who were paroled were negative on examinations for 
acid-fast bacilli for a period of 16 months or longer, previous to parole, 
and have been given intensive provocative treatment with potassium 
iodide without producing any acute manifestation of leprosy. They 
were carefully examined by the special leprosy diagnostic board and 
were considered to be in an arrested state of the disease, and non- 
infective. They had undergone routine anti-leprosy treatment for 
periods ranging from 2 years and 3 months to over 12 years. One of 



55 



them, who had presented definite psychopathic symptoms for several 
years, was subsequently sent to the Corozal Hospital for the insane. 
The others went directly to their homes. Complete follow-up service 
on these cases is not possible, but they were directed to report twice 
each year to the board of health laboratory at Ancon for examination. 

PATIENTS CONDITIONALLY DISCHARGED DURING 1929. 



Name. 


Age. 


Length of time under 
treatment. 


Length of period of 

noninfectivity before 

discharge. 


S.R 

F.H.. . 


13 years, 4 months. 

19 years, 6 months. 
41 years. 

58 years. 
34 years. 

38 years. 

39 years. 
43 years. 

20 years. 


2 years, 3 months, 21 days. 
6 years, 1 month, 12 days. 
6 years, 5 months, 23 days. 
8 years, 2 months, 9 days. 

8 years, 2 months, 19 days. 

9 years, 7 months, 2 days. 
9 years, 10 months, 20 days. 

10 years, 6 months, 16 days. 
12 years, 9 months, 1 day. 


2 years. 


M.S. 




M.P. 


4 years . 


A.B. . 


J.L. . 


3 years, 10 months. 
3 years, 5 months. 
1 year, 4 months. 
7 years. 


A.M. 


A. D 

J.M. 





No new experimental work was done at the institution during the 
year. Routine treatment consisted of intramuscular injection of the 
ethyl esters of chaulmoogric acids in doses of 3 to 6 cc. given twice a 
week, and of daily surgical dressings of leprous ulcers. Special 
ophthalmologic service for 3 cases was secured from Gorgas Hospital. 
Smears from the nasal mucosa and from skin lesions of all patients 
were examined for acid-fast bacilli each month, and in those patients 
who have apparently become noninfective this examination was made 
weekly. 

An effort was made to improve the hygienic and dietetic standards 
of the colony with noticeable results, in spite of set habits and tastes 
of the patients, although a greater number of patients were permitted 
to draw rations and prepare their own food. 

The reconstruction of the old kitchen-mess hall has given the colony 
an excellent recreation hall. The 2 pool tables are in almost con- 
stant use during the day, motion pictures are shown 3 times a week at 
which most of the patients attend, and there was dancing with refresh- 
ments during the fiestas. Religious services were held regularly 
twice each week; on Tuesdays they were conducted by the Rt. Rev. 
James Craik Morris, of the Protestant Episcopal Church, and on 
Thursdays by the Rev. Father A. E. Gay, of the Roman Catholic 
Church. 

Sixty -seven patients were employed about the colony and were paid 
$5,245.95. Produce to a value of $1,146.71 was bought from 31 
patient farmers. The practice of withholding allotment from those 
who earned- over seven dollars the previous month has taken the 
allotment fund out of its deficit, and as the practice permits a more 



56 

equitable distribution, it will be continued. During the year $1,313 
was paid out of the allotment fund in doles ranging from $1 to $2.50 
per month. 

BOARD OF HEALTH LABORATORY. 

(Operated in connection with Gorgas Hospital.) 
Dr. L. B. Bates, Chief of Laboratory. 

Bacillus typhosus. — Recovered in blood culture from 8 individuals 
and from stool specimens of 10 others. Of the 18 cases, 7 were from 
Panama, 5 from Colon, 4 direct from ships, and 2 from the Canal Zone. 
In addition, B. paratyphosus B was recovered from stools of one 
patient in Corozal Hospital for the insane. 

Typhoid carriers. — On December 31, 1928 there were 2 B. typhosus 
carriers under sanitary surveillance, H. B. and G. H., both of Panama 
City. H. B. remained positive throughout the year. G. H. either 
went to the interior or left the country. Two other temporary carriers, 
R. M. and L. R., both of Panama City, were detected during the year. 
They will be examined from time to time. There was only one B. 
typhosus carrier under sanitary surveillance on December 31, 1929, 
H. B. of Panama City. 

B. paratyphosus B infection in guinea pigs. — Infection with B. para- 
typhosus B was constantly present in the laboratory guinea pigs 
throughout the year and caused considerable loss; as fast as cleared 
out it was apparently reintroduced by new consignments from the 
United States. The local market is now supplying our needs, and it is 
hoped that with the purchase of local animals solely the infection 
can be controlled. 

Smallpox (alastrim). — During the last half of the year there was an 
epidemic of mild smallpox in the City of Panama. (See pages 17-37). 
Pus obtained from pustules of eleven of these patients was inoculated 
into multiple scarifications on the corneas of rabbits. All corneas 
were negative for the "Paul reaction" microscopically, and no sugges-* 
tion of box-cells or Guarnieri bodies could be found microscopically. 
However, the epidemic was quickly and completely controlled by 
universal vaccination. 

Venomous snakes. — One death due to snakebite, and one severe case 
of snakebite poisoning with recovery, were recorded at the laboratory 
during the year. The fatal case was a colored Panamanian (G. G.), 
age 49 years. While hunting on the bank of the Frijoles River on 
February 7, 1929, he was bitten on the right ankle by a fer-de-lance 



57 

(Bothrops atrox). He was bitten at 12.30 p. m., and died at about 
4.00 p. m. before reaching a town. No antivenin was given him. 
An autopsy was held. The snake was killed by the hunter at the 
time he was bitten and sent to the laboratory by the Canal Zone 
police the next day for indentification. It measured 5 feet and 1 inch 
in length and weighed 3| pounds; its intestinal tract was empty. 

The second case was reported by Maj. Allen R. Howard, Medical 
Corps, U. S. Army. The patient, a soldier, was bitten on the right 
thumb while clearing jungle around an observation tower some 
distance from Fort Randolph. His hand and arm became swollen 
and he became slightly delirious. The wound was opened by the man 
himself immediately after it was received, and he was given bothropic 
antivenin several hours later. The man recovered in the course of 
several days. The snake was killed but not recovered. The patient 
states that he feels sure it was a bushmaster (Lachesis mutis), but his 
prompt response to treatment with bothropic antivenin suggests the 
possibility of its having been a fer -de-lance. 

Reports. — Approximately 52,127 reports, not including duplicates, 
have been made. 

BACTERIOLOGICAL PROTOZOAL AND MISCELLANEOUS EXAMINATIONS. 

Blood cultures 215 

Positive for b. typhosus 7 

Positive for Staphylococcus albus 4 

Positive for Staphylococcus albus, hemolytic 5 

Positive for Staphylococcus aureus 5 

Positive for Streptococcus non-hemolytic 1 

Positivefor B.coli (Escherichia paragrunthali) 1 

Positive for B . pyogenesfostidus (Eberthella pyogenes) 1 

Positive for Gram negative diplococcus 2 

Positive for Pneumococci (type undetermined) 1 

Positive for Pneumococcus Type II 1 

Stools cultured for typhoid dysentery group 1,557 

Positive for B. typhosus 47 

Positivefor B. typhosus from carriers 19 

Positivefor B. paratyphosusB 2 

Positive for B. dysenteriae Group II 8 

Positivefor B. dysenteriae Group III 8 

Positivefor B.enteriditis(Gaertner) 1 

Urines cultured for typhoid group 749 

Urines cultured for orginisms other than typhoid group 464 

Positivefor B.cM 70 

Positivefor Staphylococcus albus 20 

Positivefor B.pyocyaneus 4 

Throat cultures for B . diphtheriae 4 , 895 

Positive for B. diphtheriae 487 

Positive for B. diphtheriae from carriers 46 

Culturef rom tonsil 1 

Positive for B . diphtheriae 1 

Nasal cultures for B. diphtheriae 551 

Positive forfi. diphtheriae 51 

Throat cultures for organisms other thanB.dt phtheriae 47 

Positive for Streptococcus, nonhemolytic 1 

Eye cultures 34 

Positive for Staphylococcus albus 2 

Positive for Staphylococcus aureus 3 

Positive for B. Morax-Azenfeld 1 

Ear cultures 14 

Positivefor Aspergillus niger : 1 

Mastoid cultures 10 

Positivefor Streptococcus viridans 2 

Positivefor Streptococcus, non-hemolytic 3 

Nasopharyngeal cultures 57 



58 

Sputum cultures 117 

Positive for Pneumococcus Type I 13 

Positive for Pneumococcus Type II 10 

Positive for Pneumncoccus Type III 2 

Positive for Pneumococcus Type IV 16 

Spinal fluid cultures 104 

Positive for Meningococcus 3 

Positiveforfi. infleunzae 3 

Positive for Pneumococcus 1 

Positive for Streptococcus 2 

Pleural fluid cultures 48 

Ascitic fluid cultures 2 

Knee fluid cultures 20 

Positive for Streptococcus non-hemolytic 2 

Culturefrom skin lesions 37 

Positivefor Staphylococcus aureus 1 

Smearsfrom skin lesions 4 

Culture of pusfrom various sources 17 

Positive for Staphylococcus aureus, hemolytic 1 

Autopsies cultured 98 

Organs, exudates, etc 139 

Positive f or B.dysenteriae, Mannitefermenter, Group II 1 

Surgical tissues cultured 

Milk cultured for bacterial count 212 

"Frezo" cultured for bacterial count H 

Cheese cultured for bicterial count 2 

Darkfield examinations 69 

Positive for Treponema pallidum 5 

Darkfield examination for yaws _4 

Conjunctival smears 72 

Positive for Gram negative intracellular diplococci .27 

Throat smears ' 213 

Positive (or fusiform bacillus and spirillum of Vincent' s angina 64 

Urethral smears 17 

Positive for Gram negative intracellular diplococci 8 

Vaginal smears. . ■ 30 

Positive for Gram negative intracellular diplococci 15 

Sputumfor B .tuberculosis 33 

Positive for B. tuberculosis .... 11 

Spinal fluidfor B. tuberculosis . . 34 

Positive for B. tuberculosis 

Urine for B .tuberculosis 9 

Positive for B .tuberculosis 

Cell count of spinal fluids 7 

Examination of leper suspects 12 

Positive for B .leprae 5 

Examination of lepers previous to parole 

Examination of paroled lepers 

Autogenous vaccines prepared 83 

Feces examined for parasites and ova 69 

Positive for Trichocephalus dispar ova 1 

Positivefor Ameba histolytica 2 

Urines examined for ova 1 

Differential counts 13 

Red blood counts 

White blood counts 7 

Hemoglobin estimations 3 

Blood smear (myelogenous leukemia) _ 1 

Blood films examined for malarial parasites 549 

Positivefor Tertian malarial parasites 273 

Positive fori?.. 4. mafariai parasites 146 

Positivefor Quartan malarial parisites. 4 

Positive f or E .A .and Tertian malarial parasites combined 6 

Cultures of bile .' 5 

Culture of contents from gall bladder 

Cultures of duodenal fluid 

Culture of cyst of jaw 

Culture of ulcer of leg ■ 

Smear of pus from right hip, positive for tubercule bacilli " 

Scrapings, fingernail, microscopic examination 

Paul test forsmallpox (inoculation of rabbit'seye) 18 

Water from Balboa Clubhouse swimming pool 294 

Water from Balboa Army and Navy Y.M.C. A. swimming pool 294 

Waterf rom Pedro Miguelswimming pool 159 

Waterfrom Union Club swimming pool 129 

Water from Fort Amador swimming pool 52 

Waterfrom Corozalswimming pool 28 

Waterfrom Fort Clayton swimming pool 21 

Waterfrom Hotel Washington swimming pool 

Waterfrom Panama Institute swimming pool ' 1 

Waterfrom Fort Amador 83 

Waterfrom V .S.S.Chvehnd : 16 

Wash water from freezing machines 4 

Waterfrom Health Office — Panama 2 



59 



Water from Fort Amador Beach ! 2 

Waterf rom Fort Sherman 2 

Distilled waterfrom Panama Coca Cola Co . 1 

Foodstuffs examined : 

Food cultured {or B.coli 3 

Cultures of canned ham 2 

Culture of meat from U . S . S . Cleveland 1 

Culture of oleomargarine for fungus 1 

Cultures bf emergency rations 3 

Bottles of soda water examined (orB.coli 39 

Specimens of syrup examined for B.coli 4 

Culture of vanilla extract (Balboa Clubhouse) 1 

SEROLOGICAL EXAMINATIONS. 

Wassermann tests ■ 19,299 

Kami tests 200 

Gonococcus complement fixation test 1 

Agglutination tests 148 

Positive with B. typhosus 49 

Positive with B. paratyphosusB 2 

Blood typing for transfusion 31 

Blood sera prepared by Swift-Ellis method for intraspinal injection 11 

Examinations of blood for coagulation time 8 

Analysis of Wassermann reactions. — Nineteen thousand two hundred 
and ninety-nine Wassermann tests were performed on the blood of 
13,695 persons. The results are summarized below: 

TABLE SHOWING NUMBER OF PERSONS ON WHOM BLOOD WASSERMANN TESTS WERE MADE AT 
BOARD OF HEALTH LABORATORY AND RESULTS OF TESTS, 1929. 



Race, sex, and status. 


Individuals 
positive. 


Individuals 
negative . 


Total 

individuals 

tested. 


Per cent of 

individuals 

positive. 


White, civil: 

Females 


254 

54 
2 


1,927 
696 
34 


2,181 
750 
36 


11.65 
7.20 
5.56 






Total 


310 


2,657 


2,967 


10.45 


White, military and naval: 


246 
63 


2,440 
383 


2,686 
446 


9.12 




14.13 


Total 


309 


2,823 


3,132 


9.87 


Black and mulattoes: 


1,065 
500 

19 


3,114 

2,518 

283 


4,179 

3,018 

302 


25.48 


Females ; 


16.57 
6.29 






Total 


1,584 


5,915 


7,499 


21.12 




15 


82 


97 


15 46 








2,218 


11,477 


13,695 


16.19 







In addition, Wassermann tests were made on 796 spinal fluids taken 
from 703 individuals. One hundred and twenty-six specimens from 
91 patients (12.94 per cent of the individuals) were positive. 



60 



PATHOLOGICAL EXAMINATIONS. 



Autopsies. — Four hundred and fifty-three autopsies were performed 
at the Board of Health Laboratory. The causes of death were as 
follows: 



Epidemic, endemic, and infectious diseases: 

Typhoid fever 

Estivoautumnal malaria 

Blackwater fever 

Smallpox (immediate cause of death lobar 

pneumonia) 

Measles 

Laryngeal diphtheria 

Postinfluenzal broncho pneumonia 

Acute influenzal meningitis 

Amebic dysentery 

Acute bacillary dysentery 

Bacillary dysentery (B.dysenteriae, Group 1 1) 
Bacillary dysentery (B.dysenteriae, 

Group III) 

Leprosy 

Polioencephalitis 

Acute anterior poliomyelitis 

Encephalitis lethargica 

Meningococcus meningitis 

Chickenpox 

Tetanus 

Pulmonary tuberculosis 

Tuberculous meningitis 2 

Tuberculous mesenteric and retroperitoneal 

lymph nodes 1 

Tuberculous peritonitis. . . : 3 

Acute desseminated miliary tuberculosis. . . 3 

Syphilitic aortitis 19 

Tertiary syphilis 

Syphilis of the central nervous system 

Cerebrospinal syphilis with psychosis 

Congenital syphilis 

Syphilis neonatorum 

Gonococcus infection, uterus and adnexa. . 
Pyemia and septicemia 

General diseases not included among the above: 

Carcinoma of esophagus 

Carcinoma of the stomach 

Adenocarcinoma of the sigmoid 

Carcinoma of the cervix 

Myxosarcoma of the ovary 

Carcinoma of uterus 

Carcinoma of the breast 

Epidermoid carcinoma of the leg 

Gliosarcoma of the brain 

Melanocarcinomatosis 

Epidermoid carcinoma of the epiglottis and 

larynx 

Carcinoma of the lung 

Carcinoma of the pancreas 

Recurrent carcinoma of prostate 

Lymphosarcoma 

Chondrosarcoma, primary in the right 

femur 

Chronic rheumatic endocarditis and 

myocarditis 

Pellagra 

Infantile beriberi 

Rickets 

Diabetes mellitus 

Splenic anemia 

Severe anemia 

Exophthalmic goiter 

Lipoid splenomegaly (Niemann's disease) . . 

Hodgkin's disease 

Von Jaksch's disease 

Edema of the brain 2 

Hemorrhagic disease of new born 3 

Hemophilia 1 



Diseases of the nervous system and of the or- 
gans of special sense: 

Pneumococcic meningitis 

Chronic suppurative basal meningitis 

Acute streptococcus meningitis 

Acute hemorrhagic leptomeningitis 

Multiple sclerosis 

Cerebral hemorrhage 

Thrombosis, left anterior and mid-cerebral 

arteries 

Thrombosis right middle cerebral artery. . . 

General paralysis of the insane 

Manic depressive psychosis 

Status epilepticus 

Endothelioma of the dura 

Dermoid cyst of the brain 

Acute suppurative otitis media 

Diseases of the circulatory system: 

Subacute adhesive pericarditis 

Acute bacterial endocarditis 

Healed subacute bacterial endocarditis. . . . 
Acute non-suppurative interstitial myo- 
carditis 

Angina pectoris 

Chronic myocarditis 

Mitral insufficiency 

Senile atrophy of the heart 

Aortic valvular disease of the heart 

Ruptured abdominal aneurysm 

Aneurysm of the aorta 

Coronary sclerosis with occlusion '....' 

Coronary sclerosis 

Coronary thrombosis 

Diseases of the respiratory system: 

Maxillary, ethmoidal, and sphenoidal 

sinusitis 

Streptococcus sphenoidal, and ethmoidal 

sinusitis 

Edema of the glottis 

Broncho pneumonia 

Lobar pneumonia 

Pleurisy, acute fibrinous, left 

Empyema 

Diseases of the digestive system: 

Agranulocytic angina 

Acute streptococcus infection of the throat. 

Acute follicular tonsillitis 

Perforating gastric ulcer 

Enterocolitis, acute 

Chronic ulcerative ileocolitis 

Ascariasis 

Acute suppurative appendicitis «. . . . . 

Appendicitis 

Strangulated intra-abdominal hernia 

Strangulated inguinal hernia 

Intussusception ileum 

Diverticulitis 

Ruptured gangrenous diverticulum 

Chronic ulcerative proctitis with stricture.. 

Acute yellow atrophy of the liver 

Cirrhosis of the liver 

Atrophic cirrhosis of the liver 

Cholelithiasis, impacted stone in common 
duct 

.Vonvenereal diseases of the genito-urinary 
system and adnexa: 

Glomerulonephritis (-10 y) .'. 

Chronic nephritis 



61 



Nouvenereal diseases of the genito-urinary 
system and adnexa — Continued: 

Pyelonephrosis 

Calculus pyelonephrosis 

Stricture of the urethra 

Suppurative prostatitis 

Hypertrophy of the prostate 

Non-puerperal abseess.right broad ligament. 

Chronic salpingo-oophoritis, bilateral 

Lef t tubo-ovarian abscess 

Hysterectomy 

The puerperal state: 

Ruptured tubal pregnancy 

Old complete perineal laceration 

Puerperal septicemia 

Postabortal pelvic abscess 

Eclampsia gravidarum 

Diseases of the skin and of the cellular tissue: 

Furunculosis, generalized 

Acute streptococcus cellulitis 

Cellulitis, buttock 

Myiasis of the scalp and brain 

Acute ulcerative dermatitis 

Diseases of the bones and of organs of loco- 
motion: 
Acute suppurative osteomyelitis, right 
tibia 

Malformations: 

Congenital external hydrocephalus 

Congenital malformation of the tricuspid 

valve 

Congenital malformation of the brain 

Diseases of early infancy: 

Malnutrition 

Premature birth 



Diseases of early infancy — Continued: 

Injury in delivery 1 

Atelectasis of the new born 2 

Affections produced by external causes: 

Suicide by hanging 3 

Suicide by firearms 9 

Snakebite (Fer-de-lance) 1 

Novarsenobenzol poisoning 2 

Asphyxiation by falling coal 1 

Accidental drowning 8 

Traumatism by fall into locks 1 

Traumatism by fall from building 2 

Traumatism by fall from dock 1 

Injury by diving 1 

Traumatism by fall 1 

Accidental crushing by lock valve 1 

Traumatism by bursting cap on relay barge. 1 
Traumatism by falling valve casting on 

suction dredge 1 

Traumatism by automobile 6 

Aeroplane accident 3 

Traumatism by falling lumber 1 

Homicide by clubbing 1 

Foreign body in the trachea _. . . . 1 

Perforation of sigmoid by fishbone. ....... 1 

Infected laceration of right thumb 1 

Traumatism of unknown causation 1 

Ill-defined diseases: 

Malnutrition (over 1 year of age) 1 

Undetermined 4 

Infection of undetermined origin g 

Appendix: 

Stillbirth, accidents of pregnancy 5 

Stillbirth, accidents of labor 3 

Stillbirth, syphilitic fetus 1 

Stillbirth, resulting from disease of mother. 5 

Stillbirth, cause undetermined 11 

Stillbirth, premature nonviable fetus 2 



THE MORE FREQUENT CAUSES OF DEATH FOUND AT AUTOPSY IN BOARD OF HEALTH 

LABORATORY, 1929. 



Cause of death. 




Per cent 
of 

autopsies. 



External causes 

Tuberculosis (acute and chronic) 

Pneumonia (broncho and lobar) 

Syphilis(including general paresis) 

Cancer 

Bright's disease (acute and chronic nephritis) 

Organic heart disease (acute and chronic) 

Cerebral hemorrhage 



10.59 
10.37 
8.83 
8.17 
5.07 
4.85 
2.20 
1.76 



62 



THE MORE FREQUENT CAUSES OF DEATH FOUND AY AUTOPSY IN BOARD OF HEALTH 
LABORATORY, 1904 TO 1929. 





'1 

a 
o 






.3 

=3 


3 2 


.2 


"o 


.5 




3 




M.2 


Year. 


a 

if 
|& 


o 
I 


J3 

3 


jjl 

"3 sa 


-a 
a H 

.§ £ 
8 >> 


Ja 
a. 

Q 


a 

-a fc 
c c 


-a 

-= 
a 

& 


> 

-a 

1 

a 


11 




s Q. 

■Ml 




Z 


£ 


H 


X 


< 


a 


O 


o 


H 


5 


o 


cc 


1904.... 


6 
269 


i 

60 


1 
9 




















1905 ... 


27 


3 


8 


5 


3 


9 




2 




1906.*.. 


509 


191 


22 


50 


24 


23 


39 


15 


33 




2 




1907.. . . 


496 


156 


35 


27 


40 


27 


36 


12 


58 


4 


4 


1 


1908 . ... 


361 


59 


63 


46 


26 


25 


23 


11 


14 




7 


2 


1909... 


295 


55 


37 


26 


32 


31 


11 


17 


11 


1 


5 




1910... 


451 


50 


91 


52 


30 


37 


36 


16 


10 


6 


4 


1 


1911... 


508 


83 


102 


41 


38 


36 


19 


20 


9 


11 


11 




1912... 


425 


53 


79 


23 


37 


27 


15 


22 


6 


7 


11 


2 


1913.. . 


460 


47 


89 


21 


34 


26 


8 


26 


5 


23 


12 


11 


1914... 


375 


36 


78 


6 


» 38 


12 


6 


27 


5 


14 


3 


5 


1915. ... 


328 


28 


56 


14 


20 


12 


5 


14 


2 


15 


10 


9 


1916... 


323 


25 


81 


8 


17 


20 


t 


10 


6 


9 


7 


15 


1917... 


330 ' 


24 


51 


5 


21 


23 


3 


18 


1 


3 





12 


1918... 


253 1 


38 


68 


6 


6 


12 




8 




1 





5 


1919... 


324 


22 


55 


3 


15 


14 


3 


20 


3 


10 


11 


8 


1920. . . 


334 

289 


■46 
14 


55 
37 


4 


29 
16 


11 
5 




8 


16 
17 







7 


15 


1921.. . 


2 


4 


20 


1922.. . 


262 


14 


29 


5 


19 


9 


4 


9 


3 


ti 


10 


14 


1923... 


205 


6 


17 


3 


9 


9 


5 


12 


9 


1 


11 


14 


1924.... 


263 


14 


33 


3 


29 


10 


4 


21 


1 


3 


13 


12 


1925.. . 


306 : 


15 


34 


7 


38 


11 


3 


18 


1 


3 


16 


17 


1926... 


282 


14 


32 


5 


32 


9 


2 


11 




5 


13 


25 


1927.... 


358 


27 


22 


10 


35 


17 


3 


19 


2 


1 


21 


23 


1928... 


436 


45 


40 


8 


40 


20 


3 


13 


9 


10 


19 


46 


1929.... 


453 


40 


44 


6 


48 


21 


5 


10 


4 


11 


23 


37 


Total 


8,901 


1,163 


1,260 


406 


676 


455 


258 


385 


189 


148 


238 


294 



1 Includes 32 cases of influenza. 

NUMBER OF AUTOPSIES PERFORMED REVEALING THE FOLLOWING DISEASES PER YEAR AT 
BOARD OF HEALTH LABORATORY, 1904 TO 1929. 



Year. 


-c 
B 

a 

a. . 
£ « 
a . 

"3 a 
< 


> 

>< 


pq 


1 

o 

o 

>> 

< 


00 

"at 
Eh 


Bd 

■11 


3 

5 


d 
a 

"a 

s 

to 


1904 


6 
269 
509 
496 
361 
295 
451 
508 
425 
460 
375 
328 
323 
330 
253 
324 
334 
289 
262 
205 
263 
306 
282 
358 
436 
453 
















1905 


12 
' 1 

■2 
i 2 

« 1 


7 
5 
1 
1 


7 
4 
2 
2 


2 




1 




1906 




1907 . 


1 

3 








1908. . 








1909 




1 




1910. 












1911 . 


1 


1 


1 

1 
3 
4 
2 


4 
1 
2 
1 
3 
2 
3 
3 
1 
2 
3 


1 




1912. . 


* 


1913 




2 






1914 


•3 


1 
1 
2 

7 






1915 






1916 




1 


1917 


2 


1 




1918 






1919 


'2 








1920 












1921. . 












9 


1922 








1 
1 




1923. . 












1924 








2 
3 

1 






1925 














1926 








1 






1927 












1928 
















1929 




r 




1 


5 




1 


Total 


8,901 


23 


27 


20 


22 


36 


3 


4 



All casessince 1905 were imported cases. 



63 

Per cent autopsied. — Six hundred and ten bodies (not including 13 
for storage only and 1 disinterred) passed through the laboratory ; 
453, or 74.56 per cent were autopsied. 

Maliria cirriersfound at autopsy 1 

Syphilis found at au'opsy (cases) 85 

Bacillary dysentery found at autopsy 3 

Intestinal parasites found at autopsy. — Thirty-seven cases in 453 
autopsies, or 8.17 per cent, showed one or more parasites or their ova, 
as follows: 



Ascaris 

Uncinaria 

Trichuris 

Strongyloides 



1 7 Hookworm 

18 Ameba 

10 Oxyuris 

3 Round worms and their ova 



Multiple infections occurred as follows: 



Ascaris, trichuris and uncinaria. 

Ascaris and uncinaria 

Ascaris and strongyloides 



4 Trichuris and uncinaria 

3 Trichuris, oxyuris and uncinaria. 

1 Uncinaria and strongyloides .... 



CAUSE OF DEATH FOUND AT AUTOPSY OF LEPERS IN BOARD OF HEALTH LABORATORY, 1929 



Autopsy 
No. 


Cause of death. 


Contributory cause. 


8470 
8647 
8651 


Leprosy 

Suicide by hinging 


Acute nephritis. 
Leprosy. 


8737 






8789 













MICROSCOPIC EXAMINATIONS AND REPORTS ON SURGICAL SPECIMENS. 



Eyebrow, specimen from 

Eyelids, specimens from 

Eyes, enucleated 

Conjunctive, tumor from 

Eye, specimens from 

Nose, growths from 

Ear, specimens from 

Lip, specimens from 

Tooth and alveolar process 

Soft palate, specimen from 

Nasopharynx, specimen from 

Tongue, specimens from 

Mandible, specimen from 

Jaw, specimens from 

Throat, specimen from 

Vocal cord, specimens from 

Tonsils, pairs 

Tonsil, specimen from 

Tonsils and adenoids 

Adenoids 

Pharynx, specimen from 

Neck, specimens from 

Throid gland 

Thyroid, specimens from 

Chest, specimens from 

Breast 

Breast, specimens from 

Esophagus 

Omentum, tumors from 

Stomach, portions of 

Duodenum, portions of 

Abdominal wall, specimen from 

Gallbladder 

Gall bladder, tubes, right ovary and part of 

left ovary 

Appendix and gall bladder 

Liver, specimens from, 

Spleen 

Kidney 



Prostate 

Penis, specimens from 

Testicle 

Epididymis 

Uterus 

Uterus, specimen from 

Uterus and tubes 

Uterus and ovary 

Uterus, tubes and ovaries 

Uterus, tubes and ovary 

Uterus, tube and ovary 

Uterus, tubes, ovaries and appendix 

Uterus, tube, ovary and appendix 

Uterus, tubes, ovaries, appendix and cervix . 

Uterus, tubes, ovaries and cervix 

Uterus, tubes, appendix, and biopsy of cervix 

Uterus, tubes, ovaries, fetus and placenta 

Uterus, tubes, ovary and appendix 

Uterus and appendix 

Uterus, ovary and appendix 

Uterine curettings 

Uterine curettings and tubes 

Uterine contents 

Uterine scrapings and cervix 

Cervix 

Cervix, specimens from 

Tubes 

Tubes and appendix 

Ovary 

Ovaries 

Ovary and appendix 

Tubes and ovaries 

Tube and ovary 

Tube, ovary and appendix 

Tubes, ovary and appendix 

Tube, ovary and biopsy cervix 

Appendices 

Pelvis, specimen from 

Vagina, specimen from 



27 
1 

22 
1 
3 

14 
2 
6 
8 
1 

10 
2 
3 
8 
5 
I 
161 
t 
1 



64 



Vulva, specimen from 1 

Small intestine, portion, resection of 2 

Anus, fistula 5 

Rectum and anus, specimens from 18 

Buttock, sinus from 1 

Perineal sinus 1 

Shoulder, specimens from 2 

Arm, amputated 1 

Arm, specimens from 2 

Forearm, specimens from 3 

Elbow, specimen from 1 

Wrist, tumor from tendon sheath 1 

Hand, amputated 1 

Finger, amputated 3 

Finger, specimens from 3 

Thigh, amputation of mid-third 1 

Thigh, tumor of 1 

Leg 5 

Leg, specimens from 5 

Knee, specimens from 2 

Foot, amputation of 2 



Foot, specimens from 6 

Skin and subcutaneous tissues 25 

Ribs, specimens from 2 

Bone, tumor from 

Submaxillary region, tumor from 

Submaxillary gland, tissue from 

Axilla, tumor from 

Lymph nodes, excision of 

Cyst, labial 

Placental tissue 

Placenta, sac and fetus 

Fetus and placental tissue 

Sputum 

Shoe containing foot, examination of 

Autopsy tissuesfrom Colon Hospital (41 tissues) 

sets 11 

Autopsy tissues (cases examined elsewhere, 
forwarded for microscopical exami- 
nation) 3 

Total 724 



Lesions in surgical specimens. — The principal lesions encountered 
in surgical specimens other than inflammatory, were as follows: 



Malignant tumors (cancer) : 

Scalp 

Eye 

Nose 

Lip 

Tongue 

Nasopharynx 

Neck 

Chest wall 

Breast 

Pharynx 

Esophagus 

Omentum 

Stomach 

Abdominal wall 

Liver 

Bladder 

Prostate 

Testis 

Uterus 

Vagina 

Ovary 

Chorion 

Cervix 

Rectum 

Anus 

Buttock 

Forearm 

Thigh 

Leg 

Skin 

Bone 

Parotid gland 

Cervical gland 

Cervical polyp 

Axillary glands 

Submaxillary gland 

Lymph glands 

Peptic ulcer 

Hodgkin's disease 

Sputum 



Total. 



Benign tumors: 

Nevus pilaris, forehead . 
Neurofibroma, eyelid . . . 

Angioma, eyelid 

Papilloma, conjunctiva. 

Papilloma, sclera 

Glioma, retina 

Keloid, ear 

Lymphangioma, nose . . 



Benign tumors — Continued: 

Lymphangioma, lip 

Mixed cell tumor, salivary gland 

Papilloma, vocal cord 

Neurofibroma, neck 

Lymphangioma, neck 

Riedal's struma (thyroid) 

Adenoma, thyroid 

Adenomatous goiter 

Fibroadenoma, breast 

Intercanalicular adenofibroma, breast 

Lymphangioma back 

Adenoma, prostate 

Myomata, uterus 

Polyp, uterus 

Endometriosis 

Teratoma, ovary 

Cyst, ovary 

Dermoid cyst, ovary 

Neurofibroma, wrist 

Cavernous hemangioma, mid-finger and 

forearm 

Pigmented mole, thigh 

Hemangioma hypertrophicum, ankle 

Neurofibroma, ankle 

Giant cell tumor of tendon sheaths and 

aponeuroses, foot 

Osteochondroma, rib 

Cyst, teratoma tous 

Cysts, epithelial 

Cyst, coccygeal 

Papilloma 

Fibroma, skin 

Lipoma 



Total. 



Specimens showing tuberculosis: 

Tonsils 

Sinus (chest) 

Epididymis 

Fallopian tubes and peritoneum. 

Anus 

Intestine and mesenteric nodes. . 
Lymph nodes 



Total 

Miscellaneous human examinations: 

Blood smears 

Placentae 



5 

427 



Total. 



432 



65 

WILD AND DOMESTIC ANIMALS. 

Bacteriological : Serological : 

Cultures of guinea pig spleens 718 Complement deviation tests for glanders 

Positive for B. paratyphosus B . . 590 (negative) 1 

Cultures of rabbit spleens 169 

Positive for B. paratyphosus B , . . 43 Total 1 

Culture of white mice spleens 3 Autopsies - 

CulturesoffieldmiceforB.pes<is(negative) 2 rj og ' i 

Blood films from cow for Piroplasma 2 Guinea pigs 718 

Positive for Piroplasma 1 Rabbits 169 

Blood films from horses for Trypanosoma ' ' ' 

„ .^Piroplasma 8 TotaI 888 

Positive for Piroplasma 2 „. . . . 

Blood film from mule for Piroplasma 1 Histological examinations: 

Blood cultures from cattle 4 Cow, autopsy tissues from 12 

Cultures of uterus and fetal membranes of Tumor from neck of native pigeon 1 

cows for B. abortus 2 Tti 7q 

Cultures of spleen, liver and blood from 1 otal 13 

horse 1 Rats examined: 

Blood culturefrom horse 1 Mus musculas 421 

Cow, autopsy tissues from 2 Mus alexandrinus 41 

Positive for B. tuberculosis 2 Mus norwegicus 237 

Earsfrom cattle { or B.anthracis (all negative) 24 Mus rattus 548 

Total 937 Total 1,247 

MICROSCOPIC SLIDES PREPARED. 

Surgical tissue preparations (22 frozen) 2,625 

Autopsy tissue preparations (2 frozen) 6,260 

Animal tissue preparations 206 



Total 9 , 091 

PHOTOGRAPHS. 

Smallpox patients at Gorgas Hospital 19 

M.O., Gorgas Hospital No. 303843 for passport 1 



Total 20 

CHEMICAL ANALYSES AND EXAMINATIONS. 

Alcohol determinations 3 

Alkali solutions 8 

Beverages 29 

Alcohol 1 

Beer 4 

Cognac 1 

Soda water for benzoic acid 14 

Positive for benzoic acid 1 

Soda water for saccharine determinations 4 

Positive for saccharine 1 

Whisky 5 

Blood 2,760 

Non-protein nitrogen determinations 2,192 

Urea nitrogen determinations 120 

Uric acid determinations 414 

Creatinin determinations 894 

Glucose determinations 2 , 259 

Calcium determinations 9 

Sodium chloride determinations 9 

Cholesterol determinations 4 1 

Carbon dioxide determinations 8 

Icterusindex 208 

Van den Bergh test 3 

Brine 1 

Positive for ammonia 1 

Calibration — sphygmomanometer 2 

Calx chlorinata 3 

Candle, beeswax 1 

Chloride lime (available chlorine) 2 

Color, beverage 1 

Diversol, free chlorine 5 

Drugs and chemicals. 11 

Cantharides (negative) 1 

Carbolic acid, crude 3 

Cattle dip, arsenical 1 

Drugs, indentification 5 

Hide 1 

Positive for mercury 1 

Feces for occult blood 1 

Fluid, abdominal 1 



66 

Foodstuffs 253 

Butter 6 

Cream 4 

Flour 3 

Ice cream 40 

Ice cream powder, "Frezo" 1 

Lime juice 1 

Milk, condensed 1 

Milk, dairy 180 

Milk, mother's 8 

Milk preservative 1 

Oleomargarine 8 

Formaldehyde solutions 2 

Gastric 563 

Glass, bottle fragments 1 

Oils, acidity 2 

Recoil fluids 16 

Rust, gun patches 27 

Sand (passed in urine) 1 

Spinal fluids 795 

Colloidal gold tests 660 

Ammonium sulphate tests 655 

Phenol tests 655 

Substances for identification .' 15 

Cocaine 6 

Food, lye detection 1 

Opium 5 

Pills, narcotics (negative) 1 

Powder, washing 1 

Quinine sulphate 1 

Toxicological 2 

Stomach washings (negative for alkaloid) 1 

Animal (negative) 1 

Urine , 69 

Glucose determinations 11 

Positive for glucose 2 

Hemoglobin determinations 1 

Lead determinations 8 

Positive for lead 1 

Routine analyses : . . . . 48 

Uric acid determinations '. 1 

Water (positive for ammonia) 1 

Water, alkalinity 1 

Water, chlorides 75 

Acetone, recovered (liters) 63 

Alcohol, recovered (liters) 472 

Benzol, recovered (liters) 53 

Chaulmoogra esters prepared (liters) 26 

UNDERTAKING DEPARTMENT. 

Bodies received ( 1 disinterred) 624 

Bodies embalmed 102 

Bodies cremated 150 

Bodies buried on Isthmus 399 

Bodies shipped from Isthmus (1 disenterred) 76 



GENERAL TABLES. 

Table I.— DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES 
FOR EMPLOYEES. 

ABSOLUTE NUMBERS. 







Discharges from and 
deaths in hospitals. 


Total deaths. 


, 






o 










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•2 ~£ 




3 






1 






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Year 1929: 




















White 


3,505 
12,688 


1,066 
2,400 


956 
1,952 


110 

448 


27 
141 


23 
128 


4 
13 


23,861 
66,184 


65.37 


Black 


181.33 






Total 


16,193 


3,466 


2,908 


558 


168 


151 


17 


90,045 


246.70 






Year 1928: 




















White 


3,308 
10,952 


872 
1,648 


795 
1,407 


77 
241 


21 
121 


19 
112 


2 
9 


20,985 
55,519 


57.34 


Black 


151.69 






Total. 


14,260 


2,520 


2,202 


318 


142 


131 


11 


76,504 


209.03 







ANNUAL RATE PER 1,000 EMPLOYEES. 



Year 1929: 

White 




304.13 
189.16 


272.75 
153.85 


31.38 
35.31 


7.70 
11.11 


6.56 

10.09 


1.14 
1.02 




18.65 


Black 




14.29 








Total 




214.04 


179.58 


34.46 


10.37 


9.33 


1.04 




15.23 








Year 1928: 

White 




263 . 60 
150.47 


240.32 
128.47 


23.28 
22.00 


6.35 
11.05 


5.74 
10.23 


.61 

.82 




17.33 


Black 




13.85 








Total 




176.72 


154.42 


22.30 


9.96 


9.19 


.77 




14.66 









67 



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70 



Table III. 



-DEATHS OF RESIDENTS AND DEATH RATES OF THE CANAL ZONE AND THE CITIES 
OF PANAMA AND COLON. 



Place. 


Popula- 
tion. 


Deaths. 


Annual rate per 1,000 
population. 


Total. 


Disease. 


External 
causes. 


Total. 


Disease. 


External 

causes. 


Year 1929: 


73,000 
29,850 
38,825 


1,413 
492 
298 


1,370 

467 

263 


43 
25 
35 


19.36 
16.48 

7.67 


18.77 
15.64 
6.77 


.59 




.84 




.40 






Total 


141,675 


2,203 


2,100 


103 


15.55 


14.82 


.73 


Year 1928: 


71,500 
30,000 
37,056 


1,434 
442 
316 


1,390 
426 
273 


44 
16 
43 


20.06 
14.73 
8.53 


19.44 
14.20 
7.37 


62 




.53 




1.16 






Total 


138,556 


2,192 


2,089 


103 


15.82 


15.08 


.74 







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80 



Table VI— STATISTICS REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES, 1929. 




Annual 
death rate 
per 1,000. 


White employees from the United States: 


5.17 




1.29 






Total 


6 46 






Families of white employees from the United States: 


3 47 




.37 






Total 


3 84 






White employees from the United States and their families: 


4 08 




.70 






Total 


4 78 







Number of American children born on the Isthmus during the year 175 

Deaths among American children under 1 year of age 4 

Infant mortality rate among American children (number of deaths per 1,000 live births) 22.86 



Table VII— BIRTHS AND BIRTH RATES IN THE CANAL ZONE AND THE CITIES OF 
PANAMA AND' COLON 





Popula- 
tion. 


Births. 


Rate per 1,000 population. 


Place. 


Total. 


Alive. 


Still- 
born. 


Total. 


Alive. 


Still- 
born. 


Year 1929: 


73,000 
29,850 
38,825 


2,517 
866 
538 


2,392 
822 
508 


125 
44 
30 


34.48 
29.01 
13.85 


32.77 
27.54 
13.08 


1.71 




1.48 




.77 






Total 


141,675 


3,921 


3,722 


199 


27.68 


26.27 


1.40 






Year 1928: 


71,500 
30,000 
37,056 


2,578 
801 
550 


2,458 
760 
513 


120 
41 
37 


36.06 
26.70 
14.84 


34 38 
25.33 
13.84 


168 


Colon 


1.37 
1.00 






Total 


138,556 


3,929 


3,731 


198 


28.36 


26.93 


1.43 







Table VIII.— INFANT MORTALITY RATES IN THE CANAL ZONE AND THE CITIES OF 
PANAMA AND COLON. 



Place. 


Births. 


Deaths among 
children under 
1 year of age. 


Male. 


Female. 


Total. 


Number. 


Rate per 
1,000 live- 
births. 


Year 1929: 


1,179 
434 
249 


1,213 
398 
259 


2,392 
822 
508 


339 
95 

48 


141.72 




115.57 




94.49 






Total 


1,862 


1,870 


3,722 


482 


129.50 






Year 1928: 


1,268 
415 
260 


1,190 
345 
253 


2,458 
760 
513 


364 
79 
59- 


148.09 




103.95 




115.01 






Total 


1,943 


1,788 


3,731 


502 


134.55 







81 



Table IX.— DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1929. 





13 i 

1* 


1 
"o 


Empl 


)yees. 


Nonemployees. 


Non- 
residents. 


Disease. 


White. 


Black. 


White. 


Black. 


White. 






Mili- 
tary. 


Others 


Black. 


Epidemic, endemic, and infectious diseases. 


16 
3 
2 
464 
272 
8 

397 
81 

2 
11 
75 
38 

2 

38 

77 
17 
5 

1 

16 
2 

7 
67 
2 
1 
1 
1 
1 
97 

2 
3 
7 
10 

5 

7 

1 

4 

1 

1 

14 

18 

145 

17 

9 

22 

153 

4 

278 

7 

2 

11 

12 

1 

4 

7 


3 
1 


1 


1 
1 




4 


10 
2 
2 
189 
84 
2 
1 


3 
1 


















8 


44 

53 

1 


137 
60 

2 


40 
38 

1 


53 
31 

2 


6 
6 


3 


























1 

2 

1 

37 

37 

2 

9 

21 

11 












2 




2 

3 

344 

38 


1 






3 
1 

3 








1 
3 


15 

4 


1 


1 


1 




• 
















2 
43 
.23 








2 




4 
3 

3 

28 
7 


8 
1 
1 

8 

14 

2 

1 


1 










2 
3 


1 

11 
6 
3 






Influenza, without pulmonary complications 


3 

24 
3 
2 


2 
5 
3 
5 
1 
4 
1 
1 
34 


10 


1 








1 




















1 
3 
1 


4 


4 


1 


2 
2 

9 
1 


1 














8 
2 


1 
1 






1 
1 
1 


20 


1 






















1 












2 






1 

1 

41 

3 
1 
3 
1 

1 

2 


1 


1 
















49 

6 
4 


17 


17 


17 

1 
1 


44 

4 
5 

4 
9 

3 

4 
1 


9 


1 


Tuberculosis of the meninges and central nervous 




Tuberculosis of the intestines and peritoneum. . . . 






























Tuberculosis of the bones (vertebral column 


1 




1 


1 
1 






Tuberculosis of the lymphatic system (mesenteric 

and retroperitoneal glands excepted) 

Tuberculosis of the genito-urinary system 

Tuberculosis of other organs than the above 




















1 




3 
1 






3 




2 
1 
2 
2 

72 
7 
13 
12 
25 
1 
20 


1 




Chronic or unspecified disseminated tuberculosis. . . 










"'is' 

3 
5 


1 
1 

5 
3 


2 
3 

60 
6 


2 
6 
3 
3 


1 

1 

16 

1 

7 


5 
3 
6 
1 


1 




2 




1 














6 
53 
1 
105 
4 
1 


4 

39 










4 


22 

2 

54 


3 










10 


69 
2 


18 
1 


2 












1 

8 
12 












1 




2 






















1 
1 
3 










1 




1 




3 

4 














1 
1 

2 


1 
3 


1 
























1 

3 






1 
3 
1 

5 








16 

2 

14 




7 
1 

2 












General disease's not included in the above class. 
Cancer and other malignant tumors of the buccal 
cavity 


2 




1 5 




4 





MR 21831 6 



82 



Table IX.— DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1929.— Continued. 



Disease. 






Employees. 



White. 



Black 



Nonemployees. 



White. 



Mili- 
tary. 



Other 



Black 



Non- 
residents. 



White. 



Black. 



General diseases.— Continued. 

Cancer and other malignant tumors of the 
stomach and liver 

Cancer and other malignant tumors of the 
peritoneum, intestines, and rectum 

Cancer and other malignant tumors of the female 
genital organs 

Cancer and other malignant tumors of the breast 

Cancer and other malignant tumors of the skin. . 

Cancer and other malignant tumors of other or 
unspecified organs 

Benign tumors and tumors not returned as malig- 
nant. (Tumors of the female genital organs 
excepted) 

Acute rheumatic fever 

Chronic rheumatism, osteoarthritis, gout 

Pellagra 

Rickets 

Diabetes mellitus 

Pernicious anemia 

Other anemias and chlorosis 

Diseases of the pituitary gland 

Exophthalmic goiter 

Other diseases of the thyroid gland 

Diseases of the thymus gland 

Diseases of the spleen 

Leukemia 

Hodgkin's disease 

Acute alcoholism 

Chronic alcoholism 

Alcoholic psychosis 

Other alcoholic poisoning 

Chronic lead poisoning 

Other chronic poisoning by mineral substances . . . 

Drug habit 

Other forms of chronic organic poisoning 

Other general diseases 



Diseases of the nervous system and of the organs 
of special sense. 

Encephalitis 

Simple meningitis 

Nonepidemic cerebrospinal meningitis 

Other diseases of the spinal cord 

Cerebral hemorrhage 

Cerebral embolism and thrombosis 

Hemiplegia 

Other paralysis without specified cause 

General paralysis of the insane 

Dementia precox 

Manic depressive psychosis 

Toxic psychosis 

Other forms of mental alienation 

Epilepsy 

Convulsions (nonpuerperal; 5 years and over). . . . 

Infantile convulsions (under 5 years of age) 

Chorea 

Neuritis 

Hysteria 

Other neuralgias and neuritis 

Softening of the brain 

Tumor of the brain 

Neurasthenia 

Other diseases of the nervous system 

Follicular conjunctivitis 

Trachoma 

Disease of cornea 

Disease of iris 

Disease of lens 

Disease of fundus 

Other diseases of the eye and annexa 

Diseases of the ear 

Diseases of the mastoid process 



3 

74 

45 

5 

4 

69 

38 

22 

18 

109 

133 

23 



1 






1 




2 




1 




1 


4 


3 


41 


10 


2 


3 



83 



Table IX— DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1929,-Continued. 







2 

•a 
"3 
"o 
E- 


Employees. 


Nonemployees. 


Non- 
residents. 


Disease. 


White. 


Black. 


White. 


Black. 


White. 






Mili- 
tary. 


Others 


Black. 


Diseases of the circulatory system. 




3 
3 

1 










3 

2 
1 








2 




1 






1 


1 












2 
123 

6 
81 
20 






2 
7 

3 
1 










27 
3 
4 
1 
3 


16 
1 

13 
3 
3 

16 
2 
1 


36 

5 

30 
5 


28 
1 

17 

7 


46 
2 

21 
5 


16 


1 








1 
















155 
15 
14 
5 
1 
2 

10 

114 

1 

11 

11 

7 
113 

117 

187 

17 

296 

35 

1 

51 

1 

139 

7 

53 


31 
2 
2 
1 


64 
5 
10 


13 
4 
1 


25 
2 


6 














Phlebitis 


4 
1 
1 
5 
23 






























1 

14 
1 
3 
3 

2 

2 

20 
10 

8 
92 
14 

1 
12 






Lymphangitis 

Lymphadenitis, nonvenereal 




1 

3 


1 

28 


1 

31 


2 
11 


4 










5 
1 

1 
2 

44 
38 

29 
1 


1 

2 

2 
48 

11 
16 

71 

3 


2 
5 














Hemorrhage without specified cause. (Non- 


4 

2 
1 


1 
11 

29 
14 
6 
36 
12 


1 

54 

9 

101 

3 

53 
5 










Diseases of the respiratory system. 


4 

9 

1 

14 




Other diseases of the nasal fossae and their annexa. 


1 




1 






Bronchitis unspecified (under 5 years of age) 






18 


6 


7 




42 
1 

62 
5 

17 
4 
1 
1 

14 


2 










39 
2 
2 
5 


6 

1 
3 

1 


78 

2 

23 


6 
3 


18 
1 

4 


7 


1 








5 










4 

1 

59 

2 

2 

58 
8 

12 

16 

1,404 

3 

13 

57 
2 

38 
9 
4 

67 

24 

6 

115 

29 

97 

6 

25 

4 

122 

58 


2 


1 








Congestion and hemorrhagic infarct of the lung.. . 










1 

1 
3 


8 
1 

1 

11 
1 


15 


7 


13 


2 
1 

1 

7 
1 
1 
3 

51 
1 








Other diseases of the respiratory system (tubercu- 








1 

7 
2 
3 
2 
491 
1 




Diseases of the digestive system. 


7 
1 


11 

2 

4 

1 

314 


15 
1 
5 
7 
368 
1 
2 
8 
1 
4 
2 
1 
17 

13 
3 

21 
5 

14 
2 
5 
1 

28 

16 














2 
105 


1 

76 




Other diseases of the pharynx and tonsils 


2 




1 

2 


3 
10 


5 
15 


4 
13 
1 
8 
2 
1 
20 






5 


8 












5 
1 


9 
3 
2 
4 


8 


4 

1 












Other diseases of the stomach (cancer excepted). . 
Enteritis, colitis, or entero-colitis (under 2 years 


9 


9 


8 

18 
3 

21 
6 

35 
3 
7 

11 
5 


8 
2 


1 


Intestinal autointoxication (under 2 years of age) . . 
Enteritis, colitis, or entero-colitis (2 years and over) 
Intestinal autointoxication (2 years and over). . . . 










1 
1 


10 
5 

2 


33 
4 

38 


16 
8 
5 


14 
2 
3 
1 

10 
2 

11 
3 


1 


Cestodes (hydatids of the liver excepted) 




2 


2 


1 


2 
1 

54 
17 










7 


14 
14 


11 
3 









84 



Table IX.— DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1929.— Continued. 





.2 a 


| 

"o 


Empl 


syees. 


Nonemployeee. 


Non- 
residents. 


Disease. 


White. 


Black. 


White. 


Black. 


White. 






Mili- 
tary. 


Others 


Black. 


Diseases of the digestive system. — Continued. 


201 

13 

298 


3 
5 
6 
1 


10 
4 
24 


59 

3 

53 


50 

3 

57 


14 

1 

64 


49 
5 

79 
1 


16 

2 

27 


















1 

1 

1 

17 

2 

44 

40 

16 

12 

62 
5 
3 
126 
3 
3 
3 

23 
47 
59 
64 
10 
3 

23 
18 








1 












1 
1 












3 


1 
3 




1 
8 
1 
21 
5 

4 

4 
15 


1 
2 








4 






1 
4 
4 

1 

2 
23 


6 
19 

1 
1 






2 
2 

' 3 

33 
1 
2 


3 

7 

1 

1 
6 


8 
2 

9 

8 

46 
5 
5 

35 
2 


4 
3 

2 








Peritonitis without specified cause (except 




Nonveneral diseases of the genito-urinary 
system and annexa. 

Acute nephritis (including unspecified under 10 




Chronic nephritis (including unspecified 10 years 


5 




















16 


7 


18 


46 
1 


4 














1 


2 












1 

s 

10 
4 
2 

1 


1 

3 

2 
23 
8 
2 
1 
2 
6 


1 

1 
4 
5 
4 
2 
1 
3 




Other diseases of the kidneys and annexa (puer- 


1 
3 


4 

15 
4 
9 
1 


2 
9 
8 
32 
2 


9 

12 
9 
9 
1 
1 
10 










1 


Other diseases of the urethra, urinary abscess, etc. . 






1 
3 
1 

3 

2 


4 

5 

3 

2 
2 

1 

1 
4 


4 
10 

1 
15 

11 
2 

4 
3 





















28 

34 
28 

165 

59 

19 

1 

23 

60 

8 

1 

3 

7 

37 

4 
136 

20 

132 

2 

30 

5 

1 

22 
32 


3 
6 

1 


1 

3 

7 

27 
12 
7 
1 

13 
10 
1 
1 
1 
1 
18 

2 

40 

5 

61 
1 
6 

1 


4 

10 
15 

135 

43 

8 


2 

2 
2 

1 
1 




Other nonvenereal diseases of the male genital 




Cysts and other benign tumors of the ovary 

Salpingitis and pelvic abscess (female). (Not 


























2 
1 
1 


1 




6 

44 

6 


1 

5 




































2 
5 

16 

1 
83 

14 

65 
2 

26 
5 

1 

7 
26 
















1 
2 

1 
2 








1 








Benign tumors of the female genital organs 








Non-puerperal diseases of the breast (cancer 


1 
2 

1 


4 
1 

3 


7 






The puerperal state. 
Abortion (miscarriage, premature birth, etc.) 


2 






1 






































Other surgical operations and instrumental 


1 
2 








15 
8 


1 



























85 

Table IX.— DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1929.— Continued. 



I 


- 1 


-a 

3 
o 
H 


Employees. 


Nonemployees. 


Non- 
residents. 


Disease. 


White. 


Black. 


White. 


Black. 


1 




Mili- 
tary. 


Others 


White. 


Black. 


The puerperal stale. — Continued. 


4 
43 

2 
10 

5 

46 

297 

78 

17 

1 

1 

1 

2 

6 

1 

55 

3 

5 

8 

14 

4 

24 
92 

18 
4 

6 

9 

55 

15 

14 

5 

103 


2 
6 








3 
17 


3 

31 

1 

7 

1 

8 
84 
11 

6 














1 
1 
























3 

2 
9 

41 
7 
4 
1 




Diseases of the skin and of the cellular tissue. 






1 

15 
82 
15 

3 


4 
44 
29 

2 


1 

6 

23 

4 






1 
5 


5 

27 
11 
2 






1 




1 
















1 














1 
1 
2 














1 


2 




1 
2 
1 
4 
2 
2 
4 
3 
2 

9 

26 

4 


1 
























7 


16 
1 


7 


17 


4 












1 
1 
2 


2 
3 
3 

3 

18 

4 
3 

1 

1 

10 
2 

4 
1 
14 

1 
36 

2 
12 
11 

3 
11 

1 

4 
3 


















1 


4 


1 
2 










1 


5 
• 8 

3 


2 
11 

4 

1 


5 
20 

2 




Other diseases of the skin and annexa 

Diseases of the bones and of the organs of locomotion. 


8 
2 


1 






Other diseases of the bones (tuberculosis ex- 






4 
2 

7 

9 

5 
30 


1 

1 

10 

1 

1 

12 












4 

13 
3 

2 
20 


1 
6 








9 








Other diseases of the joints (tuberculosis and 




3 


2 
1 
6 








Malformations. 


1 
1 

2 
3 

16 
2 
4 
1 

2 

2 

2 
1 


21 




Other congenital malformations (stillbirths not 


99 

1 

13 

1 

1 
8 


1 


9 


29 


25 


1 




Early infancy. 










4 
6 






























Other diseases peculiar to early infancy 








1 
















Old age. 


12 
1 

1 




4 




6 












External causes. 
Suicide, and attempted suicide by firearms 






2 


1 












1 





86 



Table IX.— DISCHARGES AND DEATHS IN HOSPITALS OF THE PANAMA CANAL, 1929.— Continued. 



Disease. 



External causes. — Continued. 



Poisoning by food 

Poisoning by venomous animals 

Other acute accidental poisonings (gas excepted).. 

Accidental burns (conflagration excepted) 

Accidental absorption of irrespirable, irritating or 

poisonous gas 

Accidental traumatism by firearms (wounds of 

war excepted) 

Accidental traumatism by cutting or piercing 

instruments 

Accidental traumatism by fall 

Accidental traumatism in mines 

Accidental traumatism in quarries 

Accidental traumatism by machines 

Railroad accident 

Street car accident 

Automobile accident 

Motorcycle accident 

Injuries by other vehicles 

Landslide, other crushing 

Injuries by animals (not poisoning) 

Gunshot wound 

Starvation (deprivation of food or water) 

Excessive heat 

Homicide and attempted homicide by firearms . . 
Homicide and attempted homicide by cutting or 

piercing instruments 

Attempted homicide by other means 

Fracture 

Dislocation 

Sprain 

Other external violence 



Ill-defined diseases. 

Cause of death not specified or ill-defined 

Not specified or unknown 

Infection of undetermined origin 

Surgical operation and shock 



Normal physiological conditions. 



Normal pregnancy 

Normal labor 

New born child 

No disease (companion, observation, etc.) . 



Total 



72 

226 
1 
1 

38 
6 
2 

75 
3 

26 

92 
7 
1 
1 
3 
2 



137 
11 
26 

339 



103 
746 
776 
455 

14,013 



Employees. 



White. 



2 

'"21 
1,067 



Black. 



2,401 



Xoncmployees. 



White. 



Mili- 
tary. 



Others 



13 
220 
235 
235 

3,011 



Black 



83 
521 
541 

82 

5,191 



Non- 
residents. 



White 



830 



Black. 



87 







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Table XL— NUMBER OF DAYS HOSPITAL TREATMENT FURNISHED, AND AVERAGE NUMBER IN 
HOSPITAL EACH DAY, OF THE VARIOUS CLASSES OF PATIENTS, 1929. 



- 


Number of days treatment. 


Average number in 


aospital each day. 


Class of patients. 


Ameri- 
can. 


Foreign. 


Black. 


Total. 


Ameri- 
can. 


Foreign. 


Black. 


Total. 


Gorgas Hospital: 


10,366 
31,080 


4,036 


40,361 


54,763 
31,080 
6,206 
11,335 
81,122 


28.40 
85.15 

7.94 
38.99 


11.06 


110.58 


150 04 




85 15 




736 
2,436 
16,994 


5,470 

6,000 

49,897 


2.02 

6.67 

46.56 


14.99 
16.44 
136.70 


17 00 




2,899 
14,231 


31.05 




222 25 






Total 


58,576 


24,202 


101,728 


184,506 


160.48 


66.31 


278.71 


505 49 






Corozal Hospital: 


103 
1,890 


365 


6,187 


6,655 

1,890 

152,851 

18,560 

29,838 


.28 
5.18 

" 3.30 


1.00 


16.95 


18 23 




5 18 




34,588 
3,287 
7,237 


118,263 
15,273 
21,395 


94.76 
9.01 
19.83 


324.01 
41.84 
58.62 


418 77 






50.85 




1,206 


81.75 






Total 


3,199 


45,477 


161,118 


209,794 


8.76 


124.60 


441.42 


574.78 










1,693 
1,391 


9,223 
15,316 


10,916 
16,707 




4.64 
3.81 


25.27 
41.96 


29 91 


Chronic medical and surgical cases 




45.77 


Colon Hospital: 


887 

4,838 

696 

3,769 


576 


3,739 


5,202 
4,838 
4,208 
16,507 


2.43 
13.25 

1.91 
10.33 


1.58 


10.24 


14.25 




13.25 




211 
2,610 


3,301 
10,128 


.58 
7.15 


9.04 
27.75 


11.53 




45.23 






Total 


10,190 


3,397 


17,168 


30,755 


27.92 


9.31 


47.03 


84 26 






Palo Seco Leper Colony: 




2,111 


25,790 
8,667 


27,901 
8,667 




5.78 


70.66 
23.75 


76.44 






23.75 














Total 




2,111 


34,457 


36,568 




5.78 


94.40 


100.19 








Total by classes: 


11,356 
37,808 


4,977 


50,287 


66,620 
37,808 
186,958 

70,393 
127,467 


31.11 
103.58 

9.85 
52.62 


13.64 


137.77 


182.52 




103.58 




37,435 

9,018 
26,841 


149,523 

57,780 
81,420 


102.56 

24.71 
73.54 


409.65 

158.30 
223.07 


512.21 


Canal Government, charity, crip- 


3,595 
19,206 


192.86 




349 23 








71,965 


78,271 


339,010 


489,246 


197.16 


214.44 


928.79 


1,340.40 











Table XII— REPORT OF DISPENSARIES, 1929. 

EMPLOYEES TREATED IN QUARTERS. 



Dispensary. 


Remaining 

January 1, 

1929. 


Admitted. 


Died. 


Discharged. 


Transferred. 


Remaining 
December 
31, 1929. 




White. 


Black. 


White. 


Black. 


White. 


Black. 


White. 


Elack. 


White. 


Black. 


White. | Black. 






8 
3 

1 
14 


789 
1,484 
261 
107 
567 


1,228 
922 






756 

1,486 

262 

107 

569 


1,146 
923 


31 


82 


2 ! 8 




3 

1 






1 2 
















143 
903 






143 
895 






1 




3 










1 22 














Total 




26 


3,208 


3,196 






3,180 


3,107 


31 


82 


4 , 33 

















Days treatment furnished. 


Average number treated 
in quarters per day. 




White. 


Black. 


Total. 


White. 


Black. 


Total. 




1,633 

2,847 

716 

334 

2,138 


4,764 

2,208 

719 
8,206 


6,397 
5,055 
716 
1,053 
10,344 


4.47 
7.80 
1.96 
.92 
5.86 


13.05 
ft. 05 

1.97 

22.48 


17.53 




13.85 




1.96 




2.89 




28.34 






Total 


7,668 


15,897 


23,565 


21.01 


43.55 


64.56 







89 



ALL CASES TREATED. 



Dispensary. 


Employees. 


Nonemployees. 


Total. 


White. 


Black. 


Total. 


White. 


Black. 


Total. 


White 


Black. 


Total. 




6,655 
13,510 
4,057 
4,250 
5,869 


20,716 
22,977 
11,938 
8,260 
15,524 


27,371 
36,487 
15,995 
12,510 
21,393 


6,326 
14,775 
9,031 
5,676 
12,523 


17,508 
14,192 
25,370 
9,608 
15,704 


23,834 
28,967 
34,401 
15,284 
28,227 


12,981 
28,285 
13,088 
9,926 
18,392 


38,224 
37,169 
37,308 
17,868 
31,228 


51,205 




65,454 




50,396 




27,794 




49,620 










79,415 


113,756 


48,331 


82,382 


130,713 


82,672 


161,797 


244,469 















Table XIII.— CONSOLIDATED ADMISSION REPORT, HOSPITALS AND DISPENSARIES, 1929. 



All class?s of patients. 


White. 


Black. 


Total. 


Admissions to hospitals, excluding Corozal farm (cripples and chronic ward) 


7,125 
3,208 


7,968 
3,196 


15,093 
6,404 








10,333 


11,164 


21,497 






Less number of patients transferred between hospitals and from quarters to 
hospitals, whose admissions are duplicated in the above figures 


239 


317 


556 




10,094 


10,847 


20,941 






Employees only. 


1,091 
3,208 


2,456 
3,196 


3,547 




6,404 








4,299 


5,652 


9,951 






Less number transferred between hospitals and from quarters to hospitals, whose 


51 


145 


196 








4,248 


5,507 


9,755 







AVERAGE NUMBER OF DATS IN HOSPITALS AND QUARTERS FOR EACH ADMISSION, EMPLOYEES ONLY. 





White. 


Black. 


Total. 


Hospitals: 


15.64 
7.91 


21.11 

10.22 


19.46 




9.44 








14.38 


19.56 


17.97 






Quarters: 


2.07 
1.91 
2.73 
3.12 
3.75 


3.85 
2.39 


3.16 




2.10 




2.73 




4.99 
8.95 


4.20 




6.96 








2.39 


4.93 


3.66 







90 



Table XIV.-STATEMENT OF CONTAGIOUS AND INFECTIOUS DISEASES REPORTED, 1929. 



Disease. 


Panama. 


Colon. 


Canal Zone. 


Outside the 

Zone and 

terminal cities. 


Total. 




New 
cases. 


Deaths. 


New 
eases. 


Deaths. 


New 

cases. 


Deaths. 


New 

cases. 


Deaths 


New 
cases. 


Deaths. 




175 

281 

3 

3 

72 
222 


5 
3 

2 
3 
5 


88 

62 

2 

2 
29 
92 


1 

3 

2 
5 
2 


30 
66 
5 

5 

964 

80 

2 

406 

(') 

2 

1 

1 


1 
1 

2 
6 

1 

27 
2 


17 
38 
51 

5 

432 

42 

9 

18 
(•> 


2 
7 

2 
15 

2 

26 


310 

447 

61 

15 

1,497 

436 

11 

582 

(') 

4 

3 

3 

5 

(■) 

32 

5 

91 


1 




8 




14 


Dysentery, Bacillary (unclassi- 
fied) 


8 




29 




7 








137 

(■) 
1 
1 


231 


21 

(■) 
1 


63 




Pneumonia (deaths only) 


347 
2 




1 
1 

2 
(■) 
12 


"32 
6 








1 
1 

(') 
5 








2 
(-) 
11 
2 
4 


204 
3 
1 




Tuberculosis (deaths only) 


64 
1 


(0 

4 
3 

48 


34 


334 
10 




1 




36 






3 






Mari t ime quaran tinable diseases: 






3 




3 






4 


2 




8 


4 












339 


1 


28 




5 




25 




397 


1 



















































1 As many cases of pneumonia and tuberculosis are not reported until death occurs, this report shows the 
number of deaths only for these two diseases. 

TABLE XV— FORCE REPORT OF HEALTH DEPARTMENT. 





December, 31 


1929. 


1928. 


1927. 




Gold. 


Silver. 


Total. 


Chief Health Office 


7 

176 

25 

19 

18 

2 
10 
11 

9 

5 


299 
52 

144 

9 

36 

23 

128 
88 

112 


7 

475 
77 

163 
27 
38 
33 

139 
97 

117 


5 

425 
62 

147 
23 
38 
37 

135 
93 

129 


6 




411 




61 




136 




21 




38 




35 




136 


Health Office, Colon 


98 




147 






Total 


282 


891 


1,173 


1,094 


1,089 







MR 21831— Panama Canal— 4-8-31— 1,000